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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 7 day of �l� , 2C i 7 <br />Contractor/Bidder (Firm) <br />Signature of Con 6act/orBid(der or Its Agent <br />&/id /N5'rO t�3 /�,i✓'f. <br />Printed Name and Title <br />Subscribed and sworn to before me this 71ve day of Je400K , 20_ZZ <br />My Commission Expires l <br />Not afy Public <br />County of Residence <br />JANET SOLLMAN <br />Seal <br />Notary Public - Stale of Indiana <br />Putnam County <br />My Commission Expires Nov 12, 2023 <br />Ver. 13 -- 6101115 <br />