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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 1.2 day of _DP, e— , 20 <br />Al <br />Printed Name and Title <br />Subscribed and sworn to before me this day of -�,e 20a <br />My Commission Expires- LO- <br />Notary Pubiic <br />County of Residence /A-,,1114 <br />Version 10/17/2018 Contractor's Bid for Public Works - 6 <br />