Common use of Conclusion Clause in Contracts

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 111 -R2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 111 -R2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 111 -R2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 Notary Public) AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WEwe, (PRINT print BIDDER, OFFEROR, QUOTER OR RESPONDENT NAMEname) , do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y22- 111-EBR2, COUNTY WIDE ROOF MAINTENANCE AND REPAIRSSTORMWATER INFRASTRUCTURE REHABILITATION SERVICES, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 123 -RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 123 -RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 123 -RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y18- 123-EBRM, COUNTY WIDE ROOF MAINTENANCE STORMWATER PIPE INSTALL AND REPAIRSREPAIR, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 1033 -MB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 1033 -MB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 1033 -MB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WEwe, (PRINT print BIDDER, OFFEROR, QUOTER OR RESPONDENT NAMEname) , do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y22- 1033-EBMB, COUNTY WIDE ROOF MAINTENANCE STORMWATER POND AND REPAIRSPRIMARY CANAL CLEANING AND RESTORATION SERVICES, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1025 -FH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1025 -FH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1025 -FH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y21- 1025-EBFH, TRAFFIC CALMING AND MINOR ROADWAY IMPROVEMENTS, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1010-R2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1010-R2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1010-R2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y21- 146-EBRM, INSTALLATION OF PAVEMENT MARKINGS, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful In our experience the proposed notice program is adequate and reasonable under the circumstances. These methods and forms of notice are consistent with the standards employed by GCG in notification programs designed to your understanding reach class members and are efficient methods of reaching potential members of the SPRClass. Xxxxxxxxxx Xxxx DECLARATION OF SHADARESE XXXX - 8 EXHIBIT 4 UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS Stericycle Class Action c/o ____________________ [ADDRESS] Postal Service: Please be informed that Do Not Mark Barcode NOTICE OF PENDENCY OF CLASS ACTION In Re: Stericycle, Inc., Steri-Safe Contract Litigation XXXX Q CLASSMEMBER 000 XXXX XX APT 1 ANYTOWN, ST 12345 Case No. 13-C-5795, MDL No. 2455 Small Quantity Stericycle Medical Waste Customers Whose Prices Were Automatically Increased Between 2003-2017 May Be Entitled to a Share of a $295 Million Settlement A $295,000,000 Settlement has been preliminarily approved by the U.S. District Court for the Northern District of Illinois, in the event case In Re: Stericycle, Steri-Safe Contract Litigation, No. 13-cv-5795, MDL No. 2455. If you are a Class Member, your rights may be affected and you may be entitled to a portion of this Settlement. Who Is Included in the Settlement? You are a conflict or inconsistency between this FAQ and the requirements member of the applicable ordinance governing specific project expenditure reportsClass if you were a Small Quantity medical waste customer of Stericycle between March 8, 2003, and Month __, 2017 and your prices were increased as the result of an Automated Price Increases. What Is This Case About? The lawsuit claims that Stericycle engaged in a practice of imposing Automated Price Increases in violation of the contracts with certain of its customers. Do I Need to Ask for Payment? You do not need to ask for payment. Your eligibility will be determined from Stericycle’s records, and your share of the Settlement will be mailed to you automatically. What Are My Options? You may choose whether to stay in the Class or not. If you do nothing, you are choosing to stay in the Class and receive your share of the Settlement. This means you will be legally bound by the Settlement, and you will not be able to sue Stericycle about the legal claims it resolves. If you stay in the Class you may object to the Settlement. You or your lawyer may ask to appear and speak at the Fairness Hearing, at your own cost. The deadline to submit objections and requests to appear is Month XX, 2017. If you wish to opt out of the Class, you must submit a notice of exclusion by Month XX, 2017. If you opt out, you will not get a share of this Settlement, but will keep any rights to sue Stericycle for the same claims in your own lawsuit. The Long Form Notice explains your options in more detail. Fairness Hearing. A Fairness Hearing will be held on __________, 2017 at the U.S. District Court for the Northern District of Illinois, Xxxxxxx XxXxxxxx Xxxxxxx Courthouse, Courtroom ##, 000 X. Xxxxxxxx St., Chicago, IL 60604. At this hearing, the ordinance controlsCourt will consider whether: 1) the Settlement is fair, reasonable, and adequate; 2) to approve service awards to Plaintiffs of the greater of $5,000 or $100 per hour; and 3) to approve the award of attorneys’ fees and expenses to Plaintiffs’ Class Counsel of $42,000,000. AlsoWhere Can I Get More Information? To get a copy of the Long Form Notice or Settlement Agreement or to learn more visit the Settlement Website at [WEBSITE]; call toll-free by phone at 0-000-000-0000, please or email at xxxxxxxxx@xxxxxxxxxxxxxxxxxxxxx.xxx. EXHIBIT 5 AGREEMENT TO ARBITRATE ________________________________ (“Claimant”) and Stericycle, Inc. (“Stericycle”) in order to resolve claims raised by Claimant arising out of or relating to the issues resolved in the Settlement Agreement reached in In re: Stericycle, Inc., Sterisafe Contract Litigation, MDL No. 2455, Case No. 1:13-cv-05795 (N.D. Ill.) and/or the issues raised in that lawsuit, hereby agree to present Xxxxxxxx’s concerns and Stericycle’s defenses to Xxx. Xxxxx Xxxxxxxx (xxx.) of JAMS (“JAMS”) for purposes of reaching through binding arbitration a full and final resolution of all such claims and potential claims of Claimant against Stericycle, its insurers, agents, employees, officers, attorneys and affiliates. The parties agree to be informed that bound by the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, JAMS Streamlined Arbitration Rules & Procedures as modified by this agreement or any other outside partywritten agreement between the parties. AccordinglyRules can be found at xxx.xxxxxxx.xxx. Xxxxxxxx agrees to pay up to $100 of the cost of arbitrating Xxxxxxxx’s claims before JAMS, if after reading this FAQ and Stericycle agrees to pay the principalbalance of fees and costs imposed by JAMS for said arbitration. The parties are free to retain lawyers, his/her authorized agent or an outside at their own expense, to represent them in the arbitration. The parties agree that they shall not seek reimbursement from the other party has for any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed fees and costs charged by the bidderlawyer, offererwhether in the context of the arbitration itself or in any other forum. Pursuant to Rule 18 of the Streamlined Arbitration Rules & Procedures, quoter or respondent the parties agree to waive an oral hearing and shall to submit the dispute to the arbitrator on the basis of written submissions as detailed herein. Claimant will provide 2 copies of all documentation to be considered by the arbitrator with this executed Agreement to Arbitration along with the fee of $100. This form and documents should be submitted to the Procurement Division Chicago JAMS resolution center at 00 Xxxxx Xxxxxx Xxxxx, Suite 3090, Chicago, Illinois 60606 attention to Xxx. Xxxxx Xxxxxxxx and served on Stericycle at 00000 Xxxxx Xxxxx Xxxxx, Lake Forest, Illinois 60045 attention to Stericycle General Counsel. Within 20 business days after being served with Xxxxxxxx’s documentation, Stericycle will submit to JAMS and serve on Claimant 2 copies of Stericycle’s responsive documents along with the balance of the fees due to JAMS for the arbitration. Xxxxxxxx and Stericycle agree that they will be bound by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any decision of the above questions, please state with whom arbitrator appointed by JAMS and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by arbitrator’s decision will be final. HeXxxxxxxx further agrees that he/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used pursue only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her caseclaims in the arbitration and will not seek to pursue claims on behalf of others or a proposed class of persons or combine or attempt to combine his/her arbitration with any other arbitration or claim. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of recordClaimant Information: Name: __________________________________________________________ Address: ________________________________________________________ City, contract purchaserState, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, Zip: ____________________________________________ Telephone number: ______________________ Email: ____________________________________________ Representative/Atty (if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member ): _____________________________________________ Rep telephone number: _________________________________ Nature of the BCC.Dispute: (A more detailed statement may be attached)

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 1046 -TA RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 1046 -TA Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 1046-TA Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y18- 1046-EBTA, UTILITIES SITE RESTORATIONS, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 20_ by _. He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 165-TA RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-165-TA ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 165-TA Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-165-TA ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 165-TA Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-165-TA ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), , to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140165-EBTA, SMALL METER INSTALLATION, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find N.J. Rule of Professional Conduct 1.7 mandates that attorneys Xxxxxxx X. Xxxxxxx and Xxxxxxx X. Xxxxxxxxx be disqualiQied from representing Quest in this FAQ useful action as their joint desire to your understanding avoid the inevitable Qinding that their unethical criminal complaint was improper now deprives Quest of unbiased legal counsel regarding this litigation that would have otherwise ended years ago. Once Quest has independent counsel, Xxxxx will then be free to decide on litigation conduct that best beneQits Quest itself as opposed to the existing feverish, scorched-earth, wasteful, and futile faux defense of a defenseless case that is driven by Mssrs. Xxxxxxx’x and Xxxxxxxxx’x desperate effort to evade deserved disciplinary action, malpractice claims, and likely termination of employment and partnership at their respective workplace. Continued litigation will inevitably be driven by Attorneys Xxxxxxx’x and Xxxxxxxxx’x continued stewardship of the SPRaction and will only work to the detriment of the Superior Court, the Appellate Division, Quest, and Xx. Please be informed Xxxxxx, who—to this day of April 16, 2022—still remains without access to his own medical records that were ;irst requested in 2019 and remains without the event billing statements he must pay to avoid Xxxxx’s initiation of collection activity and reporting of a conflict or inconsistency between this FAQ “delinquent” account to credit-rating agencies. Florham Park, NJ s/Xxxxxxx X. Xxxxxx Dated: Apr. 16, 2022 Xxxxxxx X. Xxxxxx PREPARED BY THE COURT XXXX XXXXXX(“Consumer”), Individually and the requirements on behalf of the applicable ordinance governing specific project expenditure reportsall others similarly situated, the ordinance controlsPlaintiff, v. QUEST DIAGNOSTICS INCORPORATED (“Quest”), XXXXXX XXXXXX, GITA “DOE” and DOES 1 through 10, inclusive, Defendants. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use OnlySUPERIOR COURT OF NEW JERSEY LAW DIVISION – MONMOUTH COUNTY DOCKET NO: OC CE FORM 2P Date Submitted FOR PROCUREMENTMON-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20L-1503-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will 2020 ORDER THIS MATTER having come before the Board court upon the Motion of County Commissioners Xxxxxxxx, Xxxxx & Xxxx P.C., the undersigned attorneys for final approvalDefendants, this form shall be completed by Quest Diagnostics Incorporated, (“Quest”), to dismiss Plaintiffs’ Complaint with Prejudice, and the bidderCourt having reviewed the papers submitted in support of the Motion and those submitted in opposition, offererand heard oral argument, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided good cause having been shown; IT IS on this form should change3rd day of January, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify 2022 ORDERED that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known Quest’s Motion to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information Dismiss Plaintiffs’ Complaint as to the relationship, if any, between the applicant Quest Defendants is hereby DENIED; and the County Mayor or any member it is further ORDERED that a copy of the Board within Order shall be deemed served upon all counsel of County Commissioners record within seven (BCC)7) days of its posting on e-Courts. The form will be a part of Xxx. Xxxxx X. Higgins, J.S.C. For the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCCreasons set forth below.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), , to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y19- 1046-EB, STORMWATER POND AND CANAL CLEANING SERVICES, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 1073 -RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 1073 -RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 1073 -RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y17- 1073-EBRM, OPERATION, MAINTENANCE & MONITORING OF THE LANDFILL GAS, LEACHATE AND STORMWATER MANAGEMENT SYSTEMS AT THE ORANGE COUNTY WIDE ROOF MAINTENANCE LANDFILL, AND REPAIRS, and to appear on myTO APPEAR ON MY/our behalf before any administrative or legislative body in the county considering this OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1032 –R2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1032 –R2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 1032 –R2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), , to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y21- 151-EBR2, COUNTY WIDE ROOF MAINTENANCE UNDERDRAINS INSTALLATION AND REPAIRS, and to appear on myAND TO APPEAR ON MY/our behalf before any administrative or legislative body in the county considering this OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful The Rehabilitator believes that the Plan is fair and equitable and represents the most value to your understanding Deferred Amount holders and policy holders and approval and implementation of the SPR. Please be informed that Plan is in the event best interests of a conflict or inconsistency between this FAQ Deferred Amount holders, Segregated Account policy holders, other claimants, and the requirements public in general. Dated: September 22, 2017. By: Xxxxxx X. Xxxxxxxxxx, Special Deputy Commissioner, on behalf of the applicable ordinance governing specific project expenditure reportsRehabilitator AMBAC ASSURANCE CORPORATION By: Xxxxxx XxXxxxx, President & CEO Exhibit A Corporate Organizational Chart Exhibit B Second Amended Plan of Rehabilitation Exhibit C Rehabilitation Exit Support Agreement and First Amendment to the Rehabilitation Exit Support Agreement Exhibit D Projected Financial and Operating Results Associated with Scenario 1 Exhibit E Projected Financial and Operating Results Associated with Scenario 2 Exhibit F Projected Financial and Operating Results Associated with Scenario 3 Exhibit G Projected Financial and Operating Results Associated with Scenario 4 Form of Amended Payment Guidelines (see attached) Draft — September 21, 2017 [FORM OF] PAYMENT GUIDELINES FOR PLAN OF REHABILITATION, AS AMENDED Date: September [ ], 2017 Issued by the Rehabilitator and the Special Deputy Commissioner of the Segregated Account of Ambac Assurance Corporation On March 24, 2010, the ordinance controlsCircuit Court for Dane County, Wisconsin (the “Court”)1 entered a rehabilitation order (the “Rehabilitation Order”), granting the petition of the Commissioner of Insurance of the State of Wisconsin to place the Segregated Account of Ambac Assurance Corporation (the “Segregated Account”) into rehabilitation and to appoint the Commissioner as the Rehabilitator for the Segregated Account (the “Rehabilitator”). AlsoOn January 24, please be informed that 2011, the County Attorney’s Office is not permitted Court issued an order confirming the Plan of Rehabilitation for the Segregated Account dated October 8, 2010 (the “Original Plan”). On June 11, 2014, the Court issued an order approving certain amendments to render legal advice the Original Plan (together with all supplements and Exhibits thereto, the “First Amended Plan”). On September [●], 2017, the Rehabilitator filed a further amended Plan of Rehabilitation for the Segregated Account (together with all supplements and Exhibits thereto, the “Second Amended Plan” or the “Plan”). In order to a principalfacilitate an efficient and orderly process for the submission of Policy Claims to the Segregated Account and the evaluation, his/her authorized agentprocessing, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board and payment of County Commissioners for final approval, this form shall be completed Claims by the bidderSegregated Account pursuant to the Plan, offererthe Rehabilitator hereby issues the following rules, quoter procedures and guidelines (as may be amended, modified or respondent supplemented from time to time pursuant to the terms hereof, the “Payment Guidelines”). These Payment Guidelines are being posted online at xxx.xxxxxxxxxxxxxxxxxx.xxx, and shall be submitted effective immediately on issuance. These Payment Guidelines replace and supersede the Guidelines under the Plan of Rehabilitation (Claims Processing for Policy Claims) dated as of February 18, 2011, and the Rules Governing the Submission, Processing and Partial Payment of Policy Claims of the Segregated Account of Ambac Assurance Corporation in Accordance With June 4, 2012 Interim Cash Payment Order (the “Interim Cash Payment Rules”) and the Payment Guidelines for the Plan of Rehabilitation, as amended, dated June 12, 2014. These Payment Guidelines do not apply to payments relating to financial guaranty policy no. 17548BE, known as the Procurement Division “LVM Policy,” which shall be controlled by the bidderLVM Payment Guidelines dated June 12, offerer2014, quoter or respondentas amended and supplemented from time to time. In the event any information provided on this form should changeFor illustration purposes, these Payment Guidelines are accompanied by a series of examples showing, as applicable, the applicant must file an amended form on or before disbursement of Interim Payments, the date creation of Deferred Loss Amounts and Accretion Amounts, the item is considered by reallocation of Deferred Loss Amounts, and the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name application of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLERecovery Amounts in three separate contexts: (Agent Authorization Form also required to be attachedi) Name of Applicant’s Authorized Agent: Business Address Write Down Transactions; (Street/P.O. Boxii) transactions affected by Undercollateralization; and (iii) Certain Multi-CUSIP Policies. The examples are attached hereto as Exhibits C, City D, and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE E, respectively. 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant Unless otherwise defined herein or in the performance of his or her official duty Plan, capitalized terms used herein shall have the meanings specified in Exhibit A hereto. Such meanings shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is equally applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed both the singular and filed by plural forms of such terms, unless the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCCcontext otherwise requires.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 100 -RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 100 -RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 100 -RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y17- 100-EBRM, STORMWATER SYSTEM VIDEO, CLEANING, SEALING, VOID DETECTION AND FILLING, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this _ day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope Nothing is more important to Verizon than its good name and its Customers’ trust. This is not subject to compromise. If you find engage in improper conduct, you may be terminated from your assignment on the Verizon Project. You must read and then certify that you have read these Guidelines and agree to comply with them. Failure to do this FAQ useful will result in your removal from all work on the Verizon Project. CERTIFICATION I have carefully read the GUIDELINES AND CERTIFICATIONS FOR CUSTOMER SERVICE REPRESENTATIVES WORKING ON THE VERIZON PROJECT and any attachments hereto. I agree to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ comply with these Guidelines, policies and procedures, and the requirements law including the requirement to conduct any business involving Services for the Verizon Project in accordance with the highest standards of honesty, integrity and fair dealing. I understand and agree that any violations by me of these Guidelines, laws or principles may lead to dismissal from working on the applicable ordinance governing specific project expenditure reports, the ordinance controlsVerizon Project. Also, please be informed I agree and acknowledge that the County Attorney’s Office is I am not permitted to render legal advice to a principal, his/her authorized agentan employee of Verizon, or any of its subsidiaries, parents, or affiliated companies. As such, I agree and acknowledge that I am not entitled to any of the benefits made available to employees of Verizon. I therefore waive, discharge, and release any claim for any employee benefit offered by Verizon or any of its parents, subsidiaries, or affiliated companies, including any successors thereto. This waiver specifically includes, but is not limited to, pension coverage or benefits, medical and/or dental insurance coverage or benefits, life insurance coverage or benefits, savings and investment plan benefits, employee stock options, short term incentives, long term incentives, holiday pay, separation pay or any other outside partyemployee benefit of any type or description. AccordinglyBy signing this document, if after reading I understand, agree and accept the terms contained herein. Representative Signature Print Name Title Date I certify that this FAQ employee was afforded the principal, his/her authorized agent or an outside party has any questions, opportunity to read and discuss this document prior to signing. I also certify that I have informed the employee that he/she is encouraged to contact his/her own legal counselresponsible for abiding by all terms contained herein. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Supervisor Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y19-140 1046 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y19- 1046-EB, COUNTY WIDE ROOF MAINTENANCE STORMWATER POND AND REPAIRSCANAL CLEANING SERVICES, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 102-RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 102-RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 102-RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), , to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140102-EBRM, STORMWATER PIPE VIDEO INSPECTION, CLEANING, SEALING AND RELATED SERVICES, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y14-140 -EB 194 -J2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y14-140 -EB 194 -J2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y14-140 -EB 194 -J2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y14- 194-EBJ2, STORMWATER SLIP LINING REHABILITATION SERVICES, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140164-EBFH, ORANGE COUNTY WIDE ROOF MAINTENANCE TRAFFIC SIGNS INSTALLATION SERVICES, AND REPAIRS, and to appear on myTO APPEAR ON MY/our behalf before any administrative or legislative body in the county considering this OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 164 -FH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140164-EBFH, ORANGE COUNTY WIDE ROOF MAINTENANCE AND REPAIRSTRAFFIC SIGNS INSTALLATION SERVICES, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 1099 -RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 1099 -RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB 1099 -RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 1401099-EBRM, COUNTY WIDE ROOF MAINTENANCE ROADBASE, ASPHALT, CURB, GUTTER AND MISCELLANEOUS CONCRETE REPAIRS, and to appear on myAND TO APPEAR ON MY/our behalf before any administrative or legislative body in the county considering this OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 169 -RM RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 169 -RM Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 169 -RM Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y18- 169-EBRM, INSTALLATION OF PAVEMENT MARKINGS, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding The Janus Board approved the Janus Plan, concluding that such Plan is in the best interests of the SPRJanus Target and that the interests of existing shareholders of the Janus Target will not be diluted as a result of the Xxxxx Xxxxxx. Please be informed The Janus Board unanimously recommends that shareholders of the Janus Target vote FOR approval of the Xxxxx Xxxxxx. The Xxxxxxxxx Board, including all of the Xxxxxxxxx Independent Trustees, reviewed and considered information regarding the Parent Company Transaction and the proposed Xxxxxxxxx Plan and Xxxxxxxxx Merger at multiple in-person and telephonic meetings held in September, October, November and December 2016 (the “Xxxxxxxxx Merger Evaluation Meetings”). During the Xxxxxxxxx Merger Evaluation Meetings and other times during the period, the Henderson Independent Trustees conferred privately on these matters with their independent counsel. In addition, during several Henderson Merger Evaluation Meetings, the Henderson Independent Trustees met with senior management of the Janus Adviser, as well as the Chief Compliance Officer of the Acquiring Fund and the Janus Target. The Henderson Independent Trustees also met with several independent board members of the Janus Trust. Based on their evaluation of all of the information presented and discussed, the Henderson Board, on behalf of the Henderson Target, including all of the Henderson Independent Trustees, concluded that the Henderson Merger is in the event best interests of the Henderson Target, and that the interests of the Henderson Target’s shareholders will not be diluted as a conflict or inconsistency between this FAQ result of the Henderson Merger. At a meeting held on December 9, 2016, the Henderson Board unanimously approved the Henderson Plan, and unanimously recommended that shareholders of the Henderson Target vote to approve the Henderson Plan. The Henderson Independent Trustees requested and received information provided by the Henderson Adviser, the Janus Adviser, and their respective affiliates regarding, among other things: the structure and terms of the Parent Company Transaction; the expected impact of the Parent Company Transaction on the Henderson Target and, separately, on the Henderson Adviser; information regarding Janus and the requirements Janus Adviser before and after the Parent Company Transaction, including, among other things, organization and personnel, business strategy, ownership structure, financial strength, affiliations, asset management and compliance practices and capabilities, and legal and regulatory matters; and information regarding the Janus Trust, the Janus Target and the Acquiring Fund. Among the various information reviewed and discussed at the Henderson Merger Evaluation Meetings were Janus’ investment reputation, broad U.S. product line and presence in the U.S. retail market, service quality, industry relationships, and distribution capabilities. The parties also discussed how the current Henderson and Janus businesses compare and complement each other and the synergies of the combined organization, which the Henderson Adviser and the Janus Adviser believe will benefit the Henderson Target’s shareholders. The Henderson Board considered the views of the Henderson Adviser and the Janus Adviser that combining the Henderson Target and the mutual funds advised by the Janus Adviser onto a single operating platform will create a larger fund family that will offer a broader range of investment options for investors, and that combining the Henderson Target and Janus Target presents the opportunity to achieve asset growth through combined distribution networks, to achieve economies of scale, and to operate with greater efficiency and lower overall costs. The Henderson Board reviewed and discussed the characteristics and steps of the Henderson Merger, and the advisory fees and total expenses of the Janus Target and the Acquiring Fund relative to those of the Henderson Target. The Henderson Board considered the differences in methodologies for setting advisory fees and expense limitation amounts, and the differences in processes for reviewing and extending such expense limitation amounts. The Henderson Board reviewed the characteristics of the share classes offered by the Henderson Target and the Acquiring Fund, and noted that holders of Class R6 Shares of the Henderson Target would receive Class N Shares of the Acquiring Fund and shares received by direct shareholders of the Henderson Target would be automatically exchanged for Class D Shares of the Acquiring Fund following the Henderson Merger. The Henderson Board also considered that, as part of the Henderson Merger, the Janus Adviser and its affiliates would provide the Henderson Target’s shareholders with administrative, transfer agency and distribution services that currently are provided to the Henderson Target by third parties. In assessing and approving the Henderson Plan and determining to submit the Henderson Plan to the Henderson Target’s shareholders for approval, the Henderson Board considered a variety of factors deemed relevant in their business judgment, including, but not limited to, the following: • The reputation, financial strength and resources of Janus and Henderson and the combined entity following the Parent Company Transaction; • The investment objective, principal investment strategies, and risks of the Henderson Target are the same as the investment objective, principal investment strategies, and risks of the Acquiring Fund; • The portfolio managers currently managing the Henderson Target are anticipated to serve as the portfolio managers of the Acquiring Fund; • The advisory fee rate to be paid by the Acquiring Fund is the same as the current advisory fee rate paid by the Henderson Target (any variances in advisory fees paid are the result of application of breakpoints); • The Janus Adviser’s commitment that the total annual expense ratio of each class of shares of the Acquiring Fund (after waivers and expense reimbursements) will be the same or lower than the total annual expense ratio (after waivers and expense reimbursements) of the applicable ordinance governing specific project expenditure reportsclass of shares of the Henderson Target for a period of one year after completion of the Merger; • The Janus Adviser’s pricing philosophy in setting advisory fees and expense limitation amounts; • There is not expected to be any diminution in the nature, quality and extent of services provided to the Henderson Target and its shareholders as a result of the Parent Company Transaction or the Henderson Merger, including the transition from the Henderson Target’s current service providers to the Acquiring Fund’s service providers; • The potential conflicts of the Janus Adviser and its affiliates providing the Acquiring Fund with administrative, transfer agency and distribution services that currently are provided to the Henderson Target by third-party service providers and the controls available to the Janus Board to oversee those conflicts; • The historical performance records of the Henderson Target and the Janus Target; • The Acquiring Fund will adopt the historical performance record of the Henderson Target; • The potential for increased economies of scale from a larger combined Acquiring Fund and operational efficiencies within a significantly larger mutual fund complex; • The access to Janus’ U.S. distribution channels may create the potential for broader asset growth and a more stable asset base; • The opportunity to benefit from portfolio management and operational efficiencies that include investment benefits of increased interaction with other Janus investment teams and resources; • The Henderson Merger is expected to be a “reorganization” within the meaning of Section 368(a) of the Code, and that no gain or loss is expected to be realized by the Henderson Target or its shareholders for U.S. federal income tax purposes as a result of the Henderson Merger; • The potential impact of the Janus Merger on the ability of the Acquiring Fund to utilize the Henderson Target’s existing capital loss-carry-over in a particular year; • The composition and qualifications of the Janus Trustees; • One member of the Henderson Board will join the Janus Board and participate in the oversight of the Acquiring Fund, and the remaining Henderson Trustees are expected to serve in an advisory capacity for a transition period following the Henderson Merger; • Shareholder access to additional investment options, by virtue of certain exchange rights, within Janus’ U.S. fund complex; • The uncertainty of the future of the Henderson Target if the Henderson Merger is not effected, in light of the Parent Company Transaction; • The terms and conditions of the Henderson Plan; • Shareholders of the Henderson Target will have the opportunity to vote on the proposed Henderson Merger; • All costs associated with the Henderson Target’s participation in the proposed Henderson Merger will be paid by Henderson, and not by the shareholders of the Henderson Target; • No sales charge, CDSC, commission, redemption fee or other transactional fee will be charged as a result of the proposed Henderson Merger; • The strong support expressed by the current senior management team at the Henderson Adviser for the Parent Company Transaction and the Henderson Merger; • The Henderson Merger is not conditioned on the Janus Merger, so if shareholders of the Henderson Target approve the Henderson Merger, the ordinance controlsHenderson Merger may be completed even if shareholders of the Janus Target do not approve the Janus Merger; and • The potential benefits of the Henderson Merger to the Janus Adviser and the combined Janus and Henderson entities following the Parent Company Transaction. AlsoIn its deliberations, please the Henderson Board considered all of the information it received, including the information described above, with no single factor or piece of information identified as paramount or controlling, and each Henderson Trustee may have attributed different weights to various factors. Although the Henderson Board considered the overall implications of the Parent Company Transaction and the Henderson Merger and Janus Merger on the Henderson Target as a whole, the Henderson Plan was evaluated individually on its own merits. The Henderson Board unanimously recommends that shareholders of the Henderson Target vote FOR approval of the Henderson Merger. U.S. Federal Income Tax Consequences The following is a summary of certain U.S. federal income tax consequences of the Mergers. The discussion is based upon the Code, Treasury regulations, court decisions, published positions of the Internal Revenue Service (“IRS”) and other applicable authorities, all as in effect on the date hereof and all of which are subject to change or differing interpretations (possibly with retroactive effect). The discussion is limited to U.S. persons who hold shares of the applicable Target Fund as capital assets for U.S. federal income tax purposes (generally, assets held for investment). This summary does not address all of the U.S. federal income tax consequences that may be informed relevant to a particular shareholder or to shareholders who may be subject to special treatment under U.S. federal income tax laws. No ruling has been or will be obtained from the IRS regarding any matter relating to the Mergers. No assurance can be given that the County Attorney’s Office is IRS would not permitted to render legal advice to a principal, his/her authorized agentassert, or any other outside party. Accordinglythat a court would not sustain, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” a position contrary to any of the above questionstax aspects described below. This summary of U.S. federal income tax consequences is for general information only. Each Fund’s shareholders should consult their own tax advisers regarding the U.S. federal income tax consequences of the Mergers, please state with whom as well as the effects of state, local and explain non-U.S. tax laws, including possible changes in tax law. It is a condition to the relationship: (Use additional sheets closing of paper if necessaryeach Merger that the Acquiring Fund and respective Target Fund receive an opinion from Skadden Arps, dated as of the applicable Closing Date, regarding the characterization of the Merger as a “reorganization” within the meaning of Section 368(a) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct of the Code. The opinion of Skadden Arps will be based on my knowledge U.S. federal income tax law in effect on the applicable Closing Date. In rendering its opinion, Skadden Arps will also rely upon certain representations of the management of each Fund and beliefassume, among other things, that the Mergers will be consummated in accordance with the Plans and other operative documents as described herein. An opinion of counsel is not binding on the IRS or any court. If a Merger does not qualify as a reorganization under the Code, the tax consequences could materially and adversely differ from those described herein. Assuming each Merger qualifies as a reorganization, the U.S. federal income tax consequences of the Mergers can generally be summarized as follows: • no gain or loss will be recognized by the respective Target Fund on the transfer of its assets to the Acquiring Fund in exchange for shares of the Acquiring Fund or the assumption by the Acquiring Fund of all liabilities of the respective Target Fund or upon the distribution of the shares of the Acquiring Fund to the respective Target Fund shareholders in exchange for their shares of the respective Target Fund, except that, immediately prior to the respective Merger, the respective Target Fund may be required to “mark-to-market,” and thus recognize gain or loss with respect to contracts described in Section 1256(b) of the Code or stock in a passive foreign investment company, as defined in Section 1297(a) of the Code; • the tax basis of the respective Target Fund’s assets acquired by the Acquiring Fund will be the same to the Acquiring Fund as the tax basis of such assets to the respective Target Fund immediately prior to the respective Merger, and the holding period of the assets of the respective Target Fund in the hands of the Acquiring Fund will include the period during which those assets were held by the respective Target Fund; • no gain or loss will be recognized by the Acquiring Fund upon the receipt of the assets of the respective Target Fund solely in exchange for shares of the Acquiring Fund and the assumption by the Acquiring Fund of all liabilities of the respective Target Fund; • no gain or loss will be recognized by shareholders of the respective Target Fund upon the receipt of the Acquiring Fund shares by such shareholders, provided such shareholders receive solely the Acquiring Fund shares (including fractional shares) in exchange for their respective Target Fund shares; and • the aggregate tax basis of the shares of the Acquiring Fund, including any fractional shares, received by each shareholder of this information changesthe respective Target Fund pursuant to the respective Merger will be the same as the aggregate tax basis of the respective Target Fund shares held by such shareholder immediately prior to the respective Merger, and the holding period of the Acquiring Fund shares, including fractional shares, to be received by each shareholder of the respective Target Fund will include the period during which the respective Target Fund shares exchanged were held by such shareholder. In addition, direct shareholders of Henderson Emerging Markets Fund whose Class A, C, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant or N Shares of Janus Henderson Emerging Markets Fund received in the performance Merger are exchanged for Class D Shares of his Janus Henderson Emerging Markets Fund following the Merger will not recognize any gain or her official duty shall be guilty of a misdemeanor loss on the exchange, and will take an aggregate tax basis in the second degreeClass D Shares that equals, punishable and a holding period that includes, their aggregate tax basis and holding period, as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of applicable, in the year Class A, C, I or N Shares exchanged therefor. Signature The Acquiring Fund intends to continue to be taxed under the rules applicable to regulated investment companies as defined in Section 851 of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as Code, which are the same rules currently applicable to form and does not attest each Target Fund. Prior to the accuracy applicable Closing Date of a Merger, each Target Fund will pay to its shareholders a cash distribution consisting of any undistributed investment company taxable income and/or any undistributed realized net capital gains, including any gains realized from any actual or veracity deemed sales of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant assets prior to the County’s Local Code of EthicsClosing Date, codified at Article XIII of Chapter 2 of the Orange County Codewhich may be, but is likely not to ensure be, attributable to portfolio transitioning. This distribution generally would be taxable to shareholders that all development-related items and procurement items presented are subject to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCCtax.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 151 –R2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 151 –R2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 151 –R2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y21- 151-EBR2, COUNTY WIDE ROOF MAINTENANCE UNDERDRAINS INSTALLATION AND REPAIRS, and to appear on myAND TO APPEAR ON MY/our behalf before any administrative or legislative body in the county considering this OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 195 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 195 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 195 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140195-EB, COUNTY WIDE ROOF MAINTENANCE MAINTENANCE, TESTING AND REPAIRSREPAIRS OF FUEL SYSTEMS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : FLORIDA ) COUNTY OF ) ) ss: I certify that the The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find It is requested that the Executive Office, Board of Supervisors return two executed documents, a stamped copy of this FAQ useful to your understanding Board letter, and two certified copies of the SPRMinute Order to the CAO, Real Estate Division, 000 Xxxxx Xxxx Xxxxxx, 0 xx Xxxxx, Xxx Xxxxxxx, XX for further processing. Please Respectfully submitted, XXXXX X. XXXXXXX Chief Administrative Officer DEJ:SAH CWW:WLD:dg Attachments (5) c: County Counsel Auditor-Controller Internal Services Department Probation Public Social Services Department 120th&Western.b Attachment A Department of Public Social Services 120th and Western, Los Angeles 1. Occupancy Yes No N/A 2. A Does lease consolidate administrative functions? 2 Relocates DPSS X B Does lease co-locate with other functions to better serve clients?2 X C Does this lease centralize business support functions? 2 X D Does this lease meeting the guideline of 200 sf of space per person?2 X Capital 3. A Should program be informed that in leased space to maximize State/Federal funding? X B If not, is this a long term County program? C Is it a net County cost (NCC) program X D If yes to 2 B or C; is this a capital lease or operating lease with an option? X E If no, are there any suitable County-owned facilities available? X F If yes, why is lease being recommended over occupancy in County-owned space? X G Is Building Description Report attached as Attachment B? X H Was build-to-suit or capital project considered? Project is design/build X Portfolio Management A Did department utilize CAO Space Request Evaluation (SRE)? Confirmed by Gensler study. X B Was the event space need justified? X C If a renewal lease, was co-location with other County departments considered? X D Why was this program not co-located? 1. X The program clientele requires a Astand alone@ facility. 2. No suitable County occupied properties in project area. 3. X No County-owned facilities available for the project. 4. Could not get City clearance or approval. 5. X The Program is being co-located. E Is lease a full service lease?2 With option to convert to NNN. X F Has growth projection been considered in space request? X G Has the Dept. of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, hisPublic Works completed seismic review/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before approval? X 1As approved by the Board of County Commissioners for final approvalSupervisors 11/17/98 2If not, this form shall be completed by the bidderwhy not? Please BOLD any written responses Attachment B LACO FACILITY NAME & ADDRESS SQUARE GROSS FEET: NET OWNERSHIP AVAILABLE SQUARE FT. X351 Century Detention - Detention Administration 00000 X. Xxxxxxx Xx. Xxxxxxx 00000 20,706 17,600 Financed 20,706 gross 4403 South Services Agency Administration Building 000 X. Xx Xxxxxxx Xxxx. Los Angeles 90061 2,584 1,901 Owned None X169 DPSS-Xxxxxxx XX District Office 000 X. Xxxxxxx Xxxx. Compton 90220 48,135 37,233 Owned None Y150 DPSS-Former Exposition Park Office 66,484 55,228 Owned 65,067 gross 0000 X. Xxxxxxx Xxx. Los Angeles 90037 Attachment C EXECUTION COPY RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: XXXXX XXXX LLP 000 Xxxxx Xxxx Xxxxxx Xxxxx 000 Pasadena, offererCalifornia 91101-3004 Attention: Xxx X. Xxxxxx, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondentEsq. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II THIS TRANSACTION IS THE APPLICANT A RELATIVE EXEMPT FROM CALIFORNIA DOCUMENTARY TRANSFER TAX PURSUANT TO SECTION 11929 OF THE MAYOR OR ANY MEMBER CALIFORNIA REVENUE AND TAXATION CODE. THIS DOCUMENT IS EXEMPT FROM RECORDING FEES PURSUANT TO SECTION 27383 OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questionsCALIFORNIA GOVERNMENT CODE. LEASE AGREEMENT by and between VERMONT VILLAGE HUMAN SERVICES CORPORATION, please state with whom as Lessor and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day LOS ANGELES, as Lessee Dated as of May 28, 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.2003

Conclusion. We hope you find this FAQ useful The lack of evidence on the association between seat belt use and maternal mortality due to your understanding MVC may be because of the SPR. Please be informed that in the event feasibility of a conflict or inconsistency between this FAQ conducting such research is complicated due to poor data linkage and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agentaccessibility, or any other outside partysample size. AccordinglyIMPACT OF SEAT BELT USE AND MOTOR VEHICLE CRASHES ON MATERNAL MORTALITY IN PREGNANT WOMEN: A SYSTEMATIC REVIEW By Xxxxxxxx X. Xxxxxxxxx B.Agric., if after reading this FAQ the principalUniversity of Agriculture, his/her authorized agent or an outside party has any questionsAbeokuta, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only2000 Thesis Committee Chair: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5Xxxx Xxxx, 2010) Date Updated For use after March 1PhD MPH Thesis Field Advisor: Xxxxx Xxxxxxx, 2011 Bid Number Y20-140 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be PhD MPH A thesis submitted to the Procurement Division Faculty of the Xxxxxxx School of Public Health of Emory University in partial fulfillment of the requirements for the degree of Master of Public Health in the Executive MPH program 2017 ACKNOWLEDGEMENTS My heartfelt appreciation to my loving husband for your patience and support. You were my biggest support throughout this program, I could not have done this without you. Thank you for believing in me! To my adorable children, Tolu, Tiwa and Temi, we did this! Thank you for your support. Special thanks to my dad for your unwavering support and encouragement always. You believe in me, thank you! Mom, wish you were here. Many thanks to family, friends and colleagues for all your support. I extend my sincere gratitude to Xxxx Xxxx and Xxxxx Xxxxxxx for their guidance, patience and time through this thesis process. Special thanks to Xxxx Xxxx for your support and encouragement from the inception of this thesis to the very end, you made this possible. Many thanks to Alyssa Duck and Xxx Xxx Xxxx, I will remember you. Thank you. TABLE OF CONTENTS CHAPTER I: INTRODUCTION 1 Research Goal 2 Definition of Terms 3 CHAPTER II: REVIEW OF THE LITERATURE 6 Global Burden of Maternal Mortality 6 Maternal Mortality and Motor Vehicle Crashes in Developing and Developed Countries 7 Risk Factors of Pregnancy-Associated Deaths due to Motor Vehicle Crashes 10 Global Traffic Report 12 Seat Belt Use 13 Policy Impact of Seat Belt Use 15 Compliance with Use of Seat Belts, Especially among Pregnant Women 18 Conclusion 19 Significance 19 CHAPTER III: METHODOLOGY: DATA COLLECTION AND ANALYSIS 21 Study Purpose 21 IRB and Confidentiality 21 Data Source and Search Terms for Systematic Review 21 Data Extraction 22 CHAPTER IV: RESULTS 24 Summary of Searches and Study Selection Process 24 CHAPTER V: DISCUSSION 33 Recommendations and Conclusion 37 REFERENCES 39 LIST OF TABLES Table 1: Percentage of Seat Belt Use and Fatality Rates in some Developed Countries in 2013 17 Table 2: Inclusion/Exclusion Criteria 23 Table 3: Article Description 26 Table 4: Distribution of Studies by Location and Design 26 Table 5: Frequency and Percentage of Maternal Mortality and Seat Belt Use 27 Table 6: Comparison of Maternal Mortality among Belted & Unbelted Pregnant Women 28 Table 7: Notes on Maternal Mortality from Articles (Excerpts) 30 Table 8: Frequency and Percentage of Fetal Mortality indicated in Articles 32 TABLE OF FIGURE Figure 1: Flow of information through the different phases of a systematic review 25 CHAPTER I: INTRODUCTION Over the last century, globally, maternal mortality has declined, particularly in developed nations (WHO, 2016b). According to the United Nations inter agencies, estimates of global maternal mortality ratio declined by 44% from 385 deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015 (World Bank Data, 2016), which was approximately 532,000 deaths in 1990 to an estimated 303,000 deaths in 2015 (WHO, 2016b). Yet, maternal mortality due to motor vehicle crashes is the leading cause of pregnancy-associated deaths around the world (Vladutiu & Xxxxx, 2012; Jamjute et al., 2005; Xxxxx, et al., 2010; Xxxxx-Clausen, Campbell, & Xxxxx, 2011). Maternal deaths due to traffic crashes are classified as coincidental and not pregnancy-related by the bidderWorld Health Organization; however, offererothers have argued that pregnancy is the root cause of such deaths, quoter or respondentbecause pregnant women are more susceptible to crashes (XxXxxx & Bhattacharya, 2014). In Pregnant occupants require an additional level of safety, particularly because of fetal protection, which during crashes might lead to varying degree of injury severity, and ultimately mortality for mothers and fetuses. For example, an area of concern might be the event any information provided on this form should changeabdominal protrusion and distance between the steering wheel (Vladutiu et al., the applicant must file 2013a; Klinich et al., 2008; Acar & Xxxxxx, 2004). Unfortunately, pregnant women and their safety remain an amended form on or before the date the item is considered by the appropriate board or bodyunderstudied population in motor vehicle safety research (Vladutiu et al., 2013b; Xxxxx & Strotmeyer, 2002). Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any Since seat belts are one of the above questionssafety features in a motor vehicle, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify research shows that the foregoing instrument was acknowledged before me this day use of seat belts reduces the risk of adverse maternal outcomes, 20 by including death (Klinich et al. He/she 2008). The proper use of seat belt is personally known to me or has produced as identification a secondary safety precaution, which alleviates the risks of injury severity and did/did not take an oathmortality during collision, with effect on seating position. Witness my hand and official seal in the county and state stated above on the day of As motor vehicle occupants, pregnant women occupy varying seating positions, that is, in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity front seat of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act vehicle as my/our agent (print agent’s name), , to execute any petitions a driver or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140-EB, COUNTY WIDE ROOF MAINTENANCE AND REPAIRSpassenger, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT rear seat (Duma et al., 2006). As shown in several studies, pregnant women are considered vulnerable during motor vehicle crashes. As described above, their safety can be compromised due to body size and to act shape. Consequently, the American College of Obstetricians and Gynecologists recommended the proper use of seat belts throughout pregnancy. As identified in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidderseveral studies, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification classifying and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) understanding maternal mortality after motor vehicle incidents is a form created pursuant complicated issue (Say, 2014). To aid this knowledge gap, there is a need to identify the County’s Local Code association between seat belt use and maternal mortality in pregnant women. Understanding this association would further clarify whether ineffective use of Ethicsseat belts is one cause of pregnancy-associated deaths due to motor vehicle crashes, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member results of the Board of County Commissioners (BCC). The form this thesis will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for developmentidentify efforts and recommendations to distinguish and alleviate pregnancy-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs associated deaths due to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCCmotor vehicle crashes.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 107 -CH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 107 -CH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 107 -CH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WEwe, (PRINT print BIDDER, OFFEROR, QUOTER OR RESPONDENT NAMEname) , do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y22-EB107-CH, COUNTY WIDE ROOF MAINTENANCE AND REPAIRSCONSTRUCTION SERVICES FOR THE SIDEWALK SAFETY IMPROVEMENT PROGRAM, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 198 -R2 RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 198 -R2 Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y21-140 -EB 198 -R2 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of _, 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WEwe, (PRINT print BIDDER, OFFEROR, QUOTER OR RESPONDENT NAMEname) , do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y21- 198-EBR2, OPERATION, MAINTENANCE & MONITORING OF THE LANDFILL GAS, LEACHATE AND STORMWATER MANAGEMENT SYSTEMS AT THE ORANGE COUNTY WIDE ROOF MAINTENANCE AND REPAIRSLANDFILL, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 189-TA RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 189-TA Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y22-140 -EB 189-TA Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF : I certify that the ) The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date (Printed, typed or stamped commissioned name of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. Notary Public) ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WEwe, (PRINT print BIDDER, OFFEROR, QUOTER OR RESPONDENT NAMEname) , do hereby authorize to act as my/our agent (print agent’s name), , to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y22- 000-EBXX, COUNTY WIDE ROOF MAINTENANCE AND REPAIRSXXXXX-XX-XXXXX LATERAL LINING, and to appear on my/our behalf before any administrative or legislative body in the county considering this BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY CONSIDERING THIS CONTRACT and to act in all respects as our agent in matters pertaining AND TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent Bidder STATE OF : FLORIDA ) COUNTY OF ) ) ss: I certify that the The foregoing instrument was acknowledged before me by means of ☐ physical presence, or ☐ online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. He/she is personally known to me or has produced as ☐ Personally Known; OR ☐ Produced Identification. Type of identification and did/did not take an oathproduced: . Witness my hand and official seal in the county and state stated above on the day of , in the year [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. Signature of STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 148 -CH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 148 -CH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y18-140 -EB 148 -CH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as my/our agent (print agent’s name), _, to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, IFB NO. Y20- 140Y18- 148-EBCH, COUNTY WIDE ROOF MAINTENANCE AND REPAIRSCONSTRUCTION SERVICES FOR THE SIDEWALK IMPROVEMENT PROGRAM, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this _ day of , 20 by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year _. _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 169 -CH RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 169 -CH Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 -EB 169 -CH Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) _, do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), _, to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y17- 169-EBCH, CONSTRUCTION SERVICES FOR THE ADA PEDESTRIAN SAFETY IMPROVEMENT PROGRAM, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 20_ by . He/she is personally known to me or has produced _ as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . _ Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: _ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Conclusion. We hope you find this FAQ useful to your understanding of the SPR. Please be informed that in the event of a conflict or inconsistency between this FAQ and the requirements of the applicable ordinance governing specific project expenditure reports, the ordinance controls. Also, please be informed that the County Attorney’s Office is not permitted to render legal advice to a principal, his/her authorized agent, or any other outside party. Accordingly, if after reading this FAQ the principal, his/her authorized agent or an outside party has any questions, he/she is encouraged to contact his/her own legal counsel. Attachment F FAQS For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 1062 -EB RELATIONSHIP DISCLOSURE FORM FOR USE WITH PROCUREMENT ITEMS, EXCEPT THOSE WHERE THE COUNTY IS THE PRINCIPAL OR PRIMARY APPLICANT For procurement items that will come before the Board of County Commissioners for final approval, this form shall be completed by the bidder, offerer, quoter or respondent and shall be submitted to the Procurement Division by the bidder, offerer, quoter or respondent. In the event any information provided on this form should change, the applicant must file an amended form on or before the date the item is considered by the appropriate board or body. Part I INFORMATION ON APPLICANT (BIDDER, OFFEROR, QUOTER, PROPOSER, OR RESPONDENT): Legal Name of Applicant: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) INFORMATION ON APPLICANT’S AUTHORIZED AGENT, IF APPLICABLE: (Agent Authorization Form also required to be attached) Name of Applicant’s Authorized Agent: Business Address (Street/P.O. Box, City and Zip Code): Business Phone ( ) Facsimile ( ) ATTACHMENT G PAGE 1 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20Y17-140 1062 -EB Company Name: Part II IS THE APPLICANT A RELATIVE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO IS THE MAYOR OR ANY MEMBER OF THE BCC THE APPLICANT’S EMPLOYEE? YES NO IS THE APPLICANT OR ANY PERSON WITH A DIRECT BENEFICIAL INTEREST IN THE OUTCOME OF THIS MATTER A BUSINESS ASSOCIATE OF THE MAYOR OR ANY MEMBER OF THE BCC? YES NO If you responded “YES” to any of the above questions, please state with whom and explain the relationship: (Use additional sheets of paper if necessary) ATTACHMENT G PAGE 2 OF 3 For Staff Use Only: OC CE FORM 2P Date Submitted FOR PROCUREMENT-RELATED ITEMS (November 5, 2010) Date Updated For use after March 1, 2011 Bid Number Y20-140 -EB ATTACHMENT G PAGE 3 OF 3 Company Name: Part III ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Applicant Print Name and Title of Person completing this form: STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or veracity of the information provided herein. ATTACHMENT G PAGE 3 OF 3 AGENT AUTHORIZATION FORM FOR PROCUREMENTS IN ORANGE COUNTY, FLORIDA I/WE, (PRINT BIDDER, OFFEROR, QUOTER OR RESPONDENT NAME) , do hereby authorize to act as myDO HEREBY AUTHORIZE TO ACT AS MY/our agent OUR AGENT (print agent’s namePRINT AGENT’S NAME), , to execute any petitions or other documents necessary to affect the TO EXECUTE ANY PETITIONS OR OTHER DOCUMENTS NECESSARY TO AFFECT THE CONTRACT approval APPROVAL PROCESS more specifically described as followsMORE SPECIFICALLY DESCRIBED AS FOLLOWS, IFB NO. Y20- 140Y17- 1062-EB, STORMWATER POND AND PRIMARY CANAL CLEANING AND RESTORATION SERVICES, AND TO APPEAR ON MY/OUR BEHALF BEFORE ANY ADMINISTRATIVE OR LEGISLATIVE BODY IN THE COUNTY WIDE ROOF MAINTENANCE CONSIDERING THIS CONTRACT AND REPAIRS, and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO ACT IN ALL RESPECTS AS OUR AGENT IN MATTERS PERTAINING TO THIS CONTRACT. Date: Signature of Bidder, Offeror, Quoter or Respondent STATE OF : COUNTY OF : I certify that the foregoing instrument was acknowledged before me this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , in the year . Signature of Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.