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I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for <br />public works are true and correct. <br />Dated this --2gzu44-1y�✓ ,14jj4k 7 G <br />: � ---' LORY L. 7lMMER Si tore of Contractor/E -er or agent <br />` NO`""� �,€ St. Jose . Coun <br />�a. wx : > Rti tY <br />;, .. ,. My Commission Expires 1 ll <br />�Pfemuer23, 2077 _ ry f'7C If lit <br />Printed Name and Title <br />Subscribed and sworn to before me this `-a day ° 4Z��2014 <br />My Commission Expires ZO 3 �-� <br />Not ublic <br />County of Residence • Jos!'' kl <br />F-Ceriificetion Iran Investment, E-Verify, Diversity_Iuly2012.doc <br />