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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 1/ day of &d , 201) <br />Subscribed and sworn to before me this 11,11 <br />My Commission ExpiresDhA/ 13 02 C� <br />County of Residence <br />1T <br />Cont r< r/Bidder (Firm) <br />Si nature of Contractor/Bidder or Its Agent <br />Printed NaUVId Title <br />day of f <br />►''1 �.0 m <br />o Publlle" <br />V <br />OFFICIAL SEAL <br />RUDOLF ENGEL <br />NOTARY PUBLIC, STATE OF IWNOIS <br />My Commission Expires Jan. 13, 2020 <br />Version 7/20/2018 Contractors Bid for Public Works - 6 <br />