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may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of peijury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this 12th dayofJune 20 18 <br />Larson Danielson Const.Co., Inc. <br />Contractor/Bidder (Firm) <br />dkwah-Aw- <br />L 7L] <br />ARSON DANIELSON Signature of tontractor/Bidder or Its Agent <br />0 <br />)C Flo CO IK <br />C � �R CONSTRUCTION CO, INC, Timothy F. Larson, President <br />Printed Name and Title <br />Subscribed and sworn to before me this 12th day of June 20 18 <br />My Commission Expires 9/8/23 <br />Notary Public Michele 1�< Dzielinski <br />C . <br />County of Residence <br />LaPorte <br />:A0rn,;, <br />Ml(:HILE CECETIA7D]1 <br />o!La Ports CoyMnEyph <br />MCornWsslon Exp4 <br />September 8. 2023 <br />Version 10/17/2017 Contractor's Bid for Public Works - 7 <br />