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I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this � day of ilov , 20-!j(p <br />,'B 1�R`I Contractor�i der (F' <br />1 <br />�lGo""fita, 0 Z 7 <br />8,E <br />Sign ure of Contracto id a or its gent <br />: SEAL : <br />ref i c ry <br />$ _ • �Sxout _.cQ.� Printed Name and Title <br />Subscribed and sworn to before me this I lf—�I day of O 0 <br />My Commission Expires %/ _ <br />Notary Public <br />County of Residence �i• 1 ChM <br />Version i 0/18/2016 Contractor's Bid for Public Works - 6 <br />