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ATTACHMENT E <br /> JAGBYRNE, GRANT ADMINISTRATION <br /> MIAMI-DADE COUNTY AFFIDAVITS <br /> The contracting individual or entity (governmental or otherwise) shall indicate by an "X" all affidavits <br /> that pertain to this contract and shall indicate by an "N/A" all affidavits that do not pertain to this contract. All <br /> blank spaces must be filled. <br /> The MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT; MIAMI-DADE COUNTY <br /> EMPLOYMENT DISCLOSURE AFFIDAVIT; MIAMI-DADE CRLVIINAL RECORD AFFIDAVIT; <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. <br /> I ,being first duly sworn state: <br /> Affiant <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 /> Federal Employer Identification Number(If none, Social Security) <br /> Name of Entity, Individual(s),Partners, or Corporation <br /> Doing Business As(if same as above,leave blank) <br /> Street Address City State Zip Code <br /> L MIAMI-DADE COUNTY OWNERSHIP DISCLOSURE AFFIDAVIT(Sec. 2-8.1 of the County Code) <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 is with a <br /> partnership, the foregoing information shall be provided for each partner. 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 contracts 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 /> Full Legal Name Address Ownership <br /> rk <br /> 1 of 5 <br /> 2. The full legal names and business address of any other individual (other than subcontractors, <br /> material men,suppliers, laborers, or lenders)who have,or will have, any interest(legal,equitable <br />