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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 />t✓ <br />Dated this 43 day of ri40W , 2017 <br />ContractorBi( ) <br />.r <br />Signature of'ContractorBidder or Itss Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this J - day of H'16t ra, 201 <br />My Commission Expires R'J `1 (1 l 44xoi r -;,,O <br />Motaly Public <br />County of Residence ,I <br />Ver.13-610111S <br />