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may result in forfeiture of contractual payunenis. <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 _ U - 4,k day of ° ; 20 17 <br />`1;ttJ1111111111JI/ <br />§§\OS1ON" -` vx Contrac r/Bidder (F' <br />SEAL d Signaturc ofContret r Bidder or Its gent <br />pp <br />t-i-nted Name and Title <br />!!IN <br />Subscribed and sworn to before me this day of f „ 20 ( <br />k % <br />My Commission Expires ► <br />N6iary ublic r <br />County of Residence " w <br />Version 10/17/2018 Contractor's Bid for Public Works - 6 <br />