98-24 Signed agreement Reliable (1).pdf

DocuSign Envelope ID: BCEB35BA-C87B-4AA5-9D74-S5C62ADE376A, STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal. Name of Organization; Nature's Choice NU LLC Organization Address: 1106 Millstone River Rd, Hillsborough Twp NJ 08844 PartI Check the box that represents the type of business organization: Oo Sole Proprietorship (skip Parts (1 and III, execute certification in Part |V) Oo Non-Profit Corporation (skip Parts li and III, execute certification in Part IV) oO For-Profit Corporation (any type) Bd imitea Liability Company (LLC) oO Partnership Dhimitea Partnership Dimitea Liability Partnership (LLP) Oo Other (be specific): Part O | The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a-10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR Oi No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) (Please attach additional sheets ifmore space is needed): Name of Individual or Business Entity ~~Address | Compost 360 Acquisition, LLC