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may result in k)dr i(ure ol'contractual payments, <br />i hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public worksare true and correct, <br />Gated this _jam day of __" `a , 20!? <br />�,tit�wtB LAM? <br />ttr I tttxrrrr <br />Contrav or/Bidder irm) — <br />' .'•�a ��S'�st 18, 2p ��,'•, a <br />SEAL Signature of Contractor✓Bidder ,r Its Ag t <br />1 y SSA �''"�� Printed Name and Title <br />Subscribed and sworn to before me this (;20' day of 96 - , 20 17 <br />XMy Commission expires <� � <br />N tary l"ubltc <br />County of Residence 1 p" "s <br />Version 10/17/2016 Contractor's Bid for Public Works - 6 <br />