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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 7 00- day of Main , Nil <br />SEAL BRANHAMliim <br />C - INDIANACOUNTYs 08-03-2019 <br />-bzry�tT� Lc-e �(.f ..�ewlr7us�e� <br />Contractor/Bidder (Firm) <br />Sig ture of Contractor/Bidder or Its Agent <br />J tm,� v.-- <br />Printed Name and Title <br />Subscribed and sworn to before me this 2-0 day of _►� Q�, 20n <br />My Commission Expires p �I_I ( ' 1- �. = lY <br />1 J�I6iary Public <br />County of Residence l C Lrl' le S <br />Ver. 13 — 6101115 <br />