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may result in forfeiture of contractual payments. <br />srw <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 21,120 <br />110�- <br />6i tore o�46ntractor/Plidder or Its Agent <br />Printed Name and Title <br />a' <br />Subscribed and sworn to before me this 3 d f "" 20� <br />My Commission Expires <br />County of Residence <br />ay o <br />Not ublic <br />6CELh1( i4NNLANG <br />NOTARY PUBLIC — OFFICIAL SEAL <br />State of Indiana, Lai'otle Ca Unt <br />y Commission Expires October 2 <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />