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may result in forfeiture of contractual payments. <br />m�* <br />0 <br />I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />t'or public works are true and corract. <br />Dated this _ 19th day of Dec , 2017 <br />Pemberton Dads Electric, Inc. <br />Contiactorffl or {pirm <br />(: <br />)John <br />' attire of a cior/i 3iddor or Its Agent <br />A. Ferro, President <br />Printed Naine and Title <br />Subscribed and sworn to before me this 19th-dayof December . , 20.17 <br />My Commission Expires 21212 <br />Notary ublic <br />County of Residence' St. Joseph <br />KELLY M HAIMBAUGH <br />�, Notary Public, State of Indiana <br />.•° <br />:, OTAO, <br />St. Joseph County <br />SEAS <br />Commission # 632698 <br />�� <br />10- <br />My Commission Expires <br />February 02, 2020 <br />i <br />' J <br />i <br />i <br />Version 1011712017 Contractor's Bid for Public Works - 8 Addendum 41 <br />Q <br />