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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 19 day of r� I , 20 )� <br />r <br />. ......... <br />Contractor/Bidder Firm <br />r " <br />Sign a e of`o �iacto,kidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this q day of <br />My Commission Expires it fit IZO40 <br />No " i P'LN <br />County of Residence P-A <br />4y, <br />y y� II <br />StateEAL <br />Notary Public, M� Indiana u J <br />5 <br />