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may result in forfeiture of contractual payments. <br />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 23rd day of May , 2017 <br />of Contractor/Bidder or Its Agent <br />iilary, South Bend Area <br />Name and Title <br />Subscribed and sworn to before me this 23rd day of May , 2017 <br />My Commission Expires 6/5/22 <br />Notary Publi Iis a Krueger <br />County of Residence St. Joseph <br />"av'v&,•,,, ALISHA KRUEGER <br />P,. Notary Public, State of Indiana <br />Z;SEA! "' St, Joseph County +' <br />k; +� My Commission Expires <br />NP ` <br />June 05, 2022 <br />Version 10/17/2016 Contractor's Bid for Public Works - 6 <br />