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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 Ciry in making determinations relative to conflict of interests and other laws-if questions <br /> contact the City of Decatur L.egal Department at 217J424-2807.) <br /> STATE OF Illinois ) <br /> )ss. <br /> COLJNTY OF Sangamon ) <br /> SECTION I. BUSINESS STATUS STATEMENT <br /> I,the undersigned,being duly sworn,do state as follows: <br /> A. Hanson Professional Services Inc. (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 37-0844717 <br /> B. CORPORATION <br /> The State of Incorporation is Delaware <br /> Registered Agent of Corporation in Illinois: Business Information(If Different from Above): <br /> Harvey B.Stephens 1525 South Sixth Street <br /> Name Company Address,Principal Office <br /> 205 S.5�'Street,Suite 700 Springfield.IL 62703 <br /> Address City,State,Zip <br /> Sprin�eld.IL 62701 217-788-2450 21'7-788-2503 <br /> City,State,Zip Telephone Facsimile <br /> 217-280-4271 www.hanson-inc.com <br /> Tele hone Website Address <br /> G-1 <br />