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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 ............... day of, 20 <br />_LI <br />14 <br />......... ...... O.tejeL`Y ea- <br />Printed MarneandTitle <br />Subscribed and sworn to before me this /98 day "of jbCCAO(6ft, 2017 <br />My Commission Expires O-A- <br />Notary Public <br />County of Residence 6 6k� 7' <br />Version 10/17/2016 Contractor's Bid for Public Works - 6 <br />