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1. 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 day of k b(LW , 20 )q <br />`t�s,urrtgr� <br />Notary <br />,JQE KALER <br />Public, State of Indlene <br />%SfiAL�"= <br />Elkhart County <br />Commission # 701813 <br />., <br />`'•.%Mcli.PIF' <br />My Commission Expires <br />June 1S, 2025 <br />H,xtI L)rj <br />Contractor/Bidder (Firm) <br />Si fn'ature of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this f day of :�����`'/ , 20 f <br />My Commission Expires <br />N t y Public <br />County of Residence <br />Version 8 — 02/25/14 <br />