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may result in forfeiture of contractual payments. <br />I 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 25th day of Sept. , 2018 <br />Subscribed and sworn to before me this 25th <br />My Commission Expires 615122 <br />County of Residence <br />Wa <br />of (contractor/Bidder or Its Agent <br />n Hilarv. VP of South Bend Area <br />Printed Name and Title <br />day of Se t• , 2018 <br />Notary is Alisha eger <br />St. Joseph <br />ALISHA KRUEGEFi <br />y��51111111////' <br />.QPY'?G� �Notary <br />Public, State of Indian: <br />St. St. JosephGountY <br />,SEAL' <br />* <br />MY Commission Expires <br />`'•,'�'olP��� <br />/11111 i15«�" <br />June 05, 2022 <br />Version 7/20/2018 Contractor's Bid for Public Works - 6 <br />