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may result in forfeiture of contractual payments. <br />tas <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 12th day of Dec. 20 17 <br />Subscribed and sworn to before me this 12th <br />My Commission Expires 4118/23 <br />County of Residence <br />Rieth-Riley Construction Co., inc. <br />Contractor/Bidder (Fir)L <br />—00 —11400, <br />Si of Conlractor/,Diclifie�;r Its Agent <br />Joshug,.A-106orrnick, Sales Manager <br />Printed Flame and Title <br />da'6f-', ecernberz'),'20,�7 <br />ay of-" <br />0 lie <br />No ary Public (1:6wn'E. Aiirnsitrbn <br />LaPorte <br />VV Vj <br />k�y <br />X 4 <br />3 <br />fl, 2 1 p, <br />. <br />. . . . . . . . . <br />Version 10/17/2016 Contractor's , Bid for Public Works - 6 <br />