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DISCLOSURE SVAKEMEN][ <br />Vendor must disclose any possible conflict of interest with the City of Louisville including, bat <br />not limited to, any relationship with any City ofLouisville elected official or cmp\o}ee. Your <br />response must disclose ifu known relationship exists between any principal of your firm and any <br />CkvofLooisviUc elected official or employee. If, tn your knowledge, no relationship exists, this <br />should also be stated in your response. Failure to disekise such a relationship may result in <br />cancellation Ufa contract as a result uf your response. This form must bo completed and returned <br />in order fbr your proposal to be eligible for consideration. <br />NO KNOWN RELATIONSFIIP EXISTS No known relationship exists <br />EX|S[8 (Please cxp|uinrula1ionahi ) <br />{ CERTIFY THAT: <br />|. 1, as an officer nt tbis c ganzat 100. 0r per the atiached Ictier of aul horizatinu, umdnly <br />authorized to certify the information provided herein are accurate and true as of -the date; and <br />�. My organization shall comply with all State and Federal Equal Opportunity nnd Non- <br />Discrimination requirements and conditions of employment. <br />Michael Muckala <br />Print ed Typed Name . <br />' <br />Signature <br />• <br />Territory Manager <br />City ufLnu*" ke,cobradnm«S npp Response Submitted »rcpicn :uft*aneonrporatwn <br />8 <br />