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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 J U1J 15, 20 1 7 <br />Subscribed and sworn to before rare this <br />My Commission Expires /3 <br />County of Resit <br />kC-r7- POC--CCC <br />Contractor/Bidder (F t-m) <br />Sil,,nature of Contractor/Bidder or Its Agent <br />C0/, i kL:P—�J5' I�Zc5 5s'©Eiv r <br />Printed Name and Title <br />Jamie C Kerns <br />Notary Public Seal Stale of Indiana <br />Randolph County <br />My Commission Expires 03/2512023 <br />