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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 12th day of Dec. , 2017 <br />®®���KE <br />k1GV3e?ragr� <br />t° V° <br />a INDI <br />®°011011a1rg®® <br />Subscribed and sworn to before me this 12th <br />My Commission Expires <br />County of Residence <br />al fi&Kell n . <br />Contr or/B' der (Fir <br />41 <br />S' na re of Contractor/Bidder or Its Agent <br />ustin Hilarv. South Bend Area Manager <br />Tinted Name and Title <br />day of December 2017 <br />Notary U&I Alisha Krueger <br />St. J <br />ALISHA KRUEGER <br />Notary Public. State of Indiana <br />AL "= St. Joseph County <br />My commission Expires <br />y i�ANp} June05 2022 <br />Version 101171201E Contractor's Bid for Public Works - 6 <br />