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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 /> 910 West Wingra Drive <br /> Name Company Address,Principal Office <br /> Madison, WI 53715 <br /> Address City, State,Zip <br /> 608-251-2129 608-251-8655 <br /> City, State, Zip Telephone Facsimile <br /> www.strand.com <br /> Telephone Website Address <br /> G-1 <br />