Laserfiche WebLink
Exhibit G <br /> CONSULTING ENGINEER'S DISCLOSURE AFFIDAVIT <br /> (NOTE: This Affidavit must be completely filled out and signed by any party doing business with the City. This <br /> Affidavit assists the City in making determinations relative to conflict of interests and other laws- if questions <br /> contact the City of Decatur Legal Department at 217/424-2807.) <br /> STATE OF WISCONSIN ) <br /> ) ss. <br /> COUNTY OF DANE ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> 1, the undersigned, being duly sworn, do state as follows: <br /> A. _Strand Associates, Inc.® (Hereinafter"Consulting Engineer") is a: <br /> Company Name <br /> (Place mark in front of appropriate type of business) <br /> X_Corporation(if a Corporation, complete B) <br /> Partnership(if a Partnership, complete C) <br /> Limited Liability Corporation(if an LLC, complete C) <br /> Individual Proprietorship (if an Individual, complete D) <br /> Consulting Engineer's Federal Tax Identification Number is 39-1020418 <br /> B. CORPORATION <br /> The State of Incorporation is Wisconsin <br /> Registered Agent of Corporation in Illinois: Business Information(If Different from Above): <br /> Darcie W. Gabrisko, Strand Associates, Inc.® _Strand Associates, Inc.® <br /> Name Company Address, Principal Office <br /> 1170 Houbolt Road _Madison, WI 53715 <br /> Address City, State, Zip <br /> _Joliet, IL 60431 _608-251-4843 <br /> City, State,Zip Telephone Facsimile <br /> _815-744-4200 www.strand.com <br /> Telephone Website <br /> G-1 <br />