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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 day of 20_L..l <br />Contractor/Bidder (Fi in) <br />' I 'Sig4natuii of Contonl4actorl Bidder or Its Agent <br />J44 6--a <br />Printed Name and "Title <br />Subscribed and sworn to Wore me this clay of... ' c,,q 20_1_1 <br />My Commission Expires It-10-7-5 <br />L <br />Notary Public <br />County of Residence S I . ....... wJ°Zse,f k <br />Brandon McGuire, Notary Public <br />Delaware County, State of Indiana <br />My Commission Expires <br />December 10, 2025 <br />Version 1117/2019 Contractor's Bid for Public Works - 6 <br />