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inay 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 December2017 <br />Subscribed and sworn to before me this 21 st <br />My Commission Expires <br />06/22/2022 <br />County of Residence <br />Wilburn Construction Company, LLC <br />Contractor/ 'dder (Firm) <br />Sign ure of Contractor/Bidder or Its Agent <br />Michelle Wilburn, President <br />Printed Name and Title <br />day of December , 2017 <br />Lc� <br />N tat), PublO Sherry L. White <br />St. Joseph <br />Version 10/17/2016 Contractor's Bid for Pubkic Works - 5 <br />