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Exhibit G <br /> The corporate officers are as follows: <br /> President: John Latshaw <br /> Vice President: <br /> Secretary: <br /> C. PARTNERSHIP OR LLC <br /> The partners or members are as follows: (Attach additional sheets if necessary) <br /> Name Home Address&Telephone <br /> Name Home Address&Telephone <br /> Name Home Address&Telephone <br /> The business address is <br /> Telephone: Fax: <br /> D. INDIVIDUAL PROPRIETORSHIP <br /> The business address is <br /> Telephone: Fax: <br /> My home address is <br /> Telephone: Fax: <br /> SECTION H. NON-COLLUSION STATEMENT (501LCS 105/3;65 ILCS 5/3.1-55-10) <br /> A. This bid is made without any connection or common interest in the profits with any other person other <br /> than the Professional Service Provider except as listed on a separate attached sheet to this affidavit. <br /> Check One: <br /> Others Interested in Contract X None <br /> B. No department director or any employee or any officer of the City of Decatur has any financial interest, directly or <br /> indirectly, in the award of this contract except as listed on a separate attached sheet to this affidavit. <br /> G-2 <br />