238-25 Exhibit B.pdf

a i i] t STATEMENT OF OWNERSHIP DISCLOSURE NLS.A, 52:25-24,2 (PL, 1977, ¢.33, as amended by P.L. 2016, 0,43) This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure Co subutit the required information is cause for automatic rejection of the bid or proposal, Name of Organization: & KA BOWS tt Cons TUTE AS, ine Organization Address: tt 6 UO CTNAIELD AVE, WAT OLRUG &, uf 6 1082, Part I Cheek the box that represents the type of business organization: ia Sole Proprietorship (skip Parts 1 and 1, execute certification in Part 1V) CI non-Prot Corporation (skip Parts IT and II, execute certification in Part TV) Eafcr-prott Corporation (any type) Dr rimited Liability Company (LLC) EI eartnersti Ip . CTimited Partnership DA cinitea Liability Parinership (LLP) Dother (be specific): ii 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, cr 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 O No one stockholder in the corporation owns 10 percent or more of its stock, of atty class, or no individual partner in the partnership owns a 10 percent ot greater interest therein, or no member in the limited lability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) (Please attach additional sheets if more space is needed): Name of Individuat or Business Entity Address » CAPO BAA ST Cle0n WWE Sona CG EAB CUE WET OMe, NP 67052. ; Koen KS STEPH GCAOGiSK Ae a One Bo S{ taoken AVE Hor. & GeAGOWS WEST OLALEE, UF O708 1 18