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R <br /> t <br /> Exhibit G <br /> 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 Illinois ) <br /> )ss. <br /> COUNTY OF Macon ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> I,the undersigned,being duly sworn,do state as follows: <br /> A. URS Corporation (Hereinafter"Consulting <br /> 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 <br /> (if an LLC,complete C) <br /> Individual Proprietorship(if an Individual,complete D) <br /> Consulting Engineer's Federal Tax Identification Number is <br /> B. CORPORATION <br /> The State of Incorporation is_Nevada <br /> Registered Agent of Corporation in Illinois: Business Information(if Different from Above): <br /> John 600 Montgomery Street, 26`" <br /> Schwalbach Floor <br /> Name Company Address,Principal Office <br /> 345 E. Ash Avenue Suite B <br /> San Francisco,CA 94111- <br /> Address 2728 <br /> City, State,Zip <br /> Decatur,IL. <br /> 62526 415 774 2700 <br /> City, State,Zip <br /> Telephone Facsimile <br /> G-1 <br />