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may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of per ury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this 21 day of August , 2017 <br />A <br />Signature o Co tracttorlBi <br />dder or Its Agent <br />-K�S'S . KWSU(). Se evc-1I .-I/ <br />Printed Name and Title <br />Subscribed and sworn to before me this day of L, 20 17 <br />My Commission Expires 4-15?- 2DZ 1 <br />County of Residence <br />S � 1 •r...rrr•� /S/ �I <br />�� � .'pNfRFlRfs•. y e <br />Z -;e�-r`� olARY <br />Pu61�G <br />Version 10117/2016 Contractor's Bid for Public Works - 6 Revised Per Addendum No 5 <br />