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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 Ww 11 th day of Dec. 2018 <br />Subscribed and sworn to before me this 11 th <br />My Commission Expires <br />March 1, 2020 <br />County of Residence <br />Ziolkowski Construction, Inc. <br />Contractor/Bidder (Firm) <br />Si ature of Contractor/Bidder gn or Its Agent <br />Bill Favors, President <br />Printed Name and Title <br />day of_December 20 18 <br />Notary Public Shannon Reidenbach <br />St Joseph <br />SHANNON REIDENBACH <br />Notary Public- Seal <br />State of Indiana <br />My Commission Expires Mar 1, 2020 <br />Version 7/20/2018 Contractor's Bid for Public Works - 6 <br />