261-25 Cerbo Submission.pdf

STATEMENT OF OWNERSHIP DISCLOSURE Nul.8.A, 52:25-24.2 (P.L. 1977, ¢.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 Oraanization. C £7CB0's l peck PEAY Gegenkuuses ene tdi 170 LitHelas Rd. Vaesizeany, UT ovosy Part | Check the box that represents the type of business organization: soe Proprietorship (skip Parts II and ill, execute certification in Part IV) Dnon-Proft Corporation (skip Parts I] and III, execute certification in Part IV) Palror-Proft Corporation (any type) DAhimitea Liability Company (LLC) lotrer (be specific): . Part Il 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 pereent-or-greater-interest therein,-as-the-case-may-be.(GOMPLETE-THE LIST BELOW IN-THIS————-—-—: SECTION) OR 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 if more space is needed): Name of Individual or Business Entity Address Aavdony CERO) IL 27) Brann Al?-Cameen ed Newrmerns, NIO78G 0 Toseph R.Cacba v7 BJT h woe TF ear\ Newren, NT o7 $e 0 Cyarty. A Cooper 2¢ Brie\\ayg Ro DarsiPeann WI o7dsy 7B