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<br />ATTACHMENT 1 <br /> <br />MIAMI-DADE COUNTY AFFIDAVITS <br /> <br />The contracting individual or entity (governmental or otherwise) shall indicate by an "X" all affidavit~ <br />that pertain to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. Al <br />blank spaces must be filled. <br /> <br />The MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI-DADE COUNTY <br />EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRIMINAL RECORD AFFIDA VIT; <br />DISABILITY NONDISCRIMINATION AFFIDAVIT; and the PROJECT FRESH START AFFIDAVIT shall <br />not pertain to contracts with the United States or any of its departments or agencies thereof, the State or any <br />political subdivision or agency thereof or any municipality of this State. The MIAMI-DADE FAMILY LEAVE <br />AFFIDAVIT shall not pertain to contracts with the United States or any of its departments or agencies or the <br />State of Florida or any political' subdivision or agency thereof; it shall, however, pertain to municipalities of the <br />State of Florida. All other contracting entities or individuals shall read carefully each affidavit to determine <br />whether or not it pertains to this contract andinitial to the left of the statement, if applicable; or "N/ A" if not <br />applicab\~o pr tie the information requested. <br /> <br />I, <br /> <br /> <br />, being first duly sworn state: <br /> <br />The full legal name and business address of the person(s) or entity contracting or transacting business with <br />Miami-Dade County are (post Office addresses are not acceptable): <br /> <br />C5- O~~(,4'l <br />Federal Employer Identification Number (rfnone, Social Security) <br /> <br />C'r\-" of Su..'-'\V\v l.s\es Gead, <br />Name of ntity, Individual s , Partners, or Corporation <br /> <br />Doing Business As (if same as above, leave blank) <br /> <br />H~O~lO Cot t\ ~~ ~ Sv.l-\\n ~\~J Dead" \:::L jJ 160 <br />Street Address C ty State Zip Code <br /> <br />00 I MIAMI-DADE COUNTY OWNERSmP DISCLOSURE AFFIDAVIT (Sec. 2-8. i of the County Code) <br /> <br />..J <br /> <br />1. If the contract or business transaction is with a corporation, the full legal name and business address <br />shall be provided for each officer and director and each stockholder who holds directly or indirectly <br />five percent (5%) or more of the corporation's stock. If the contraCt or business transaction iswith a <br />partnership, the foregoing information shall be provided for each partneL If the contract or business <br />transaction is with a trust, the full legal name and address shall be provided for each trustee and each <br />beneficiary. The foregoing .requirements shall not pertain to '~ontracts. with publicly traded <br />corporations or to contracts with the United States or any department or agency thereof, the State or <br />any political subdivision or' agency thereof or any municipality of this State. All such names and <br />addresses are (post Office addresses are not acceptable): <br /> <br />Bof 16 <br /> <br />t/;~ <br />