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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 /> 1,the undersigned,being duly sworn,do state as follows: <br /> A. URS Corporation (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 <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 Schwalbach 600 Montgomery Street.26h Floor <br /> Name Company Address,Principal Office <br /> 345 East Ash Avenue, Suite B San Francisco,CA 94111-2728 <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.urscgw.com <br /> Telephone Website <br /> G-1 <br />