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I hereby affir-a under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are tone and correct. <br />Dated this �_ day ofjuN] , 20_ s <br />=Soal <br />liver <br />ate of Indianaountyes 06/1212az2 <br />Contractor/Biddet Firth) <br />Signature of Contractor/Bidder or Its Agent <br />4�z mid X. C�GC:/��40 <br />Printed Name and Title <br />Subscribed and sworn to before me this � � day of J UN C , 20 19 <br />My Commission Expires U�p-2~20�2���� � _ <br />Notary Public �j <br />County of Residence ! 1 To S ` 1 ' <br />Version 8 — 02/25/14 <br />