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may result in forfeiture of contractual payments. <br />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 otidj11 C- , 20_ <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO.710399 <br />E K1( U Iyl 6MCLt-!E 5E U <br />Vr7e <br />acdr (F'rm) 44 <br />Jz, , ,, <br />ignature o Contr ctor idder or It gent <br />Printed Name and Title <br />Subscribed and sworn to before me this day of J U K)C , 20 <br />My Commission Expires aI I.aaw-(, R N �Oazyu j-i,- <br />N tart' Public <br />County of Residence [,M)A Pi (i <br />Version 10/17/2017 Contractor's Bid for Public Works - 7 <br />