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may result in forfeiture of contractual payments. <br />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 7j IvfAAf 'dayof_ "'T 20 <br />C ontrscta .P aides (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />— OA/ VA 075 <br />Printed Name and Title <br />Subscribed and sworn to before me this dray of „p, �� � k � 20 <br />My Commission Expires q ) <br />N airy l�� l�lmC d <br />County of Residence <br />�JENNIFER M DUPUIE <br />NOTARY Public <br />WAYNE COUNTY, STATE OF MICHIGAN <br />MY COMMISSION EXPIRES 0I.2b-202 I <br />Version 7/20/201 S Contractor's Bid for Public Works - 7 <br />