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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 A&AA, 2016 <br />Contractor/Bidder (Firm <br />Signature of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this day ofQ'Cewbt�' , 201Q <br />My Commission Expires 0(:-h)bel?- 2D, Q 3 <br />otary Public <br />County of Residence // /H 1lzaA Z. <br />--- --, <br />Esrnr: - - - - - VO W Seal"- , <br />i KamMM E. Whey r <br />° 1181011Y Public, >t ba of Indlans <br />f Resident of ilgraMll Co., w ; <br />My canuals" expires r <br />2023 <br />Version 10/18/2016 Contractor's Bid for Public Works - 6 <br />