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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 _ _ day of 41„ <br />Contractor/Bidder (Firrri <br />n No ��vN SUMMERS <br />aloe, of Contractor/Bidder or Its Agent <br />Elkhart County —Notary Sat of lllndiana- <br />Commission Number 711261 Printed Name and Title <br />My Commission Expires Met 8, 2026 <br />Subscribed and sworn to before nie this day cif®� _ �'2 _... <br />My Commission Expires ( n K6 � w Vt �,,. <br />Notary Public <br />County of Residence <br />Version 7/20/2018 Contractor's Bid for Public Works - 6 <br />