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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 t" t A"O_) 1 <br />ID-S coU(t-r SbLLnI0W <br />Contractor/Bidder (Firm) <br />FOFFICIAL��!-�lirrSignature of C tractor/Bidder or Its Agent <br />�L FORMANIC:, STATE OF ILLINOISnExpires08105/2018 .4 )eANbP-A MEPEI2GAr-4- WIEM <br />Printed Name and Title <br />Subscribed and sworn to before me this <br />My Commission Expires 0 <br />County of Residence <br />day of �� ' , 201/ <br />c <br />'�— <br />Notary Public <br />LA 145 <br />Version 7/31/2015 Contractor's Bid for Public Works - 6 <br />