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Exhibit G <br /> Exhibit G <br /> CONSLJLTING ENGINEER'S DISCLOSURE AFFIDAVIT <br /> (NOTE: This Affidavit mus( be completely filled out and signed by any party doing business with the City. This <br /> A.tridavit assists the City in staking determinations relative to conflict of interests and other laws -if questions <br /> contact the. City ol'Decatur Legal Department tit 217/424-2807.) <br /> STATE OF Illinois ) <br /> ss. <br /> COUNTY OF Macon } <br /> SECTION 1. BUSINESS STATUS STATEMENT <br /> I, the undersigned, being duly sworn,do state as follows: <br /> A. URS Corporation (Hereinafter"Consulting Engineer")is a.- <br /> Company <br /> :Company Name <br /> (Place mark in front of appropriate type of business) <br /> Corlxmâ–ºtion of a Corporation. complete Bl <br /> Partnership(11'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 381776252 <br /> B. CORPORATION <br /> The State of Incorporation is Nevada <br /> Registered Agent of Corporation in Illinois: Business Information (If DifTerent from Above): <br /> John Schwalbach 600 Montgomery Street. 26'b Floor <br /> Name Company Address, Principal Office <br /> 345 East Ash Avenue Suite B San Francisco CA 941 1 1-2728 <br /> Address City, State,Zip <br /> Decatur IL 62526 415-774-2700 415-398-1905 <br /> City, State,Zip Telephone Facsimile <br /> 217-875-4800 www.ursrorr).com <br /> Telephone Website <br /> G-i <br />