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l 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 4 � day of� ., 20 <br />cc <br />Contractor/Bidder (Firm) <br />Signat e of Contractor/Bidder or Its Agent <br />Printed Name and 'title <br />Subscribed and sworn to before e this day of 0 , 2t� <br />My Commission Expires <br />Notary Public <br />County of Residence <br />Version 8 — 02/25/1.4 <br />