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i <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 Affidavit <br /> assists the City in making determinations relative to conflict of interests and other laws-if questions contact the City of <br /> 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. Bainbridge,Gee,Milanski&Associates(Hereinafter"Consulting Engineer")is a: <br /> Company Name <br /> (Place mark in front of appropriate type of business) <br /> I <br /> X Corporation(if a Corporation,complete B) <br /> i <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 37-0982232 <br /> i <br /> B. CORPORATION <br /> The State of Incorporation is DELAWARE <br /> I <br /> I <br /> Registered Agent of Corporation in Illinois: Business Information(If Different from Above): <br /> i <br /> H.David Harp i <br /> Name Company Address,Principal Office <br /> BGM Engineering f <br /> 1670 S.Taylorville Rd. <br /> i <br /> Address City, State,Zip <br /> i <br /> Decatur IL 62521 217 423-8677 <br /> City, State,Zip Telephone Facsimile i <br /> 217 423-8600 BGMengineerina.com <br /> Telephone Website I <br /> i <br /> G-1 I <br /> i <br />