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r,xninit � <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 /> 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 /> _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]dentification Number is 37-0982232 <br /> B. CORPORATION <br /> The State of Incorporation is Delaware <br /> Registered Agent of Corporation in Illinois: Business Information (If Different from Above): <br /> Michael H. Price <br /> Name Company Address, Principal Office <br /> BGM Engineering <br /> 1670 S. Ta lorville Rd. <br /> Address City, State, Zip <br /> Decatur, IL 62521 217 423-8600 <br /> City, State, Zip Telephone Facsimile <br /> (2l7) 423-8600 BGMengineering.com <br /> Tele hone Website <br /> G-1 <br />