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may result in forfeiture of contractual payments. <br />•ss <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- <br />M <br />Printed Name and "Title <br />Subscribed and sworn to before me this day of , �4 <br />My Commission Expires 0 -a - 0I <br />Notaroub is <br />County of Residence 1) 1-k <br />KELLY AMCa9 LANC <br />NOTARY P <br />UBLIC OFFICIAL SEAL <br />State of Indiana <br />Commission 202 <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />