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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 17th day of April 20 19 <br />Ancon Construction Co., Inc. <br />Coal , c ')r/l iddei, ,irm) m <br />Sign, arare of Contractor/Bidder or Its Agent <br />J an D. Place, President <br />Printed Name and Title <br />17th <br />Subscribed and sworn to before me this _....... ...... . c:$a of April 19 <br />1 /20/23 <br />My Commission Expires <br />Notary Public <br />County of Residence Elkhart <br />Version 1/17/2019 Contractor's Bid for Public Works - 53 <br />