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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 14th day of MIL, 2019 <br />* LpRPORgTF"�,�. <br />�P�tP�tt�t� <br />Subscribed and sworn to before me this 14th <br />My Commission Expires <br />6/5/22 <br />MM Shrim-gym <br />of <br />or Its Agent <br />Dustin Hilarv, VP of South Bend Area <br />Printed Name and Title <br />day of _...............:.: 2019 <br />Notary ublic A1166a Krueger <br />County of Residence St. Joseph <br />AL.ISHA KRUEGER <br />Notary Public, State of Indiana <br />;. <br />SEAL; <br />St. Joseph County <br />"= * "• *" <br />My commission Expires <br />Ju e0Jw 2022 <br />Version 1/17/2019 Contractor's Bid for Public Works - 6 <br />