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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 21 st day of Dec , 20 17 <br />Brown & Brown General Contractors, Inc. <br />Contractor/Bi er (Fxrm) <br />Signature of Contractor/Bidder or Its Agent <br />Eric Brown, President <br />Printed Name and Title <br />Subscribed and sworn to before me this 21 St dayof <br />Dec. 2+0- 1177 <br />My Commission Expires 4/3/2025 <br />County of Residence <br />Notary Public <br />Marshall <br />,555555!!!11l1� <br />OF l[� .• <br />'111111111110\ <br />Version 10/17/2016 Contractor's Bid for Public Works - 5 <br />