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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 <94�k day of �crilst , 20� 7 <br />Subscribed and sworn to before me this <br />My Commission Expires <br />i <br />t":nnYrar r/Ririrl�Fir� -- �-_-�-� C-- <br />Signature 6f"ContractgWdder or Its Agent <br />Printed Name and Title <br />S+�- da, 20 y of a��y}� ) % <br />Notary,ublic <br />County of Residence <br />Version 10/17/2016 Contractor's Bid for Public Works - 6 <br />