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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 12th day oiNovember 2019 <br />Michiana Contracting Inc <br />ContractorJl idde (I I Il"nn) <br />I Z I I <br />S nature of Contrau r/'bidder or Its Agent <br />Scott Kirkpatrick, President <br />Printed Name and Title <br />12th y November 19 <br />Subscribed and sworn to before me this day of __ 20� <br />M Commission Expires aiA <br />Y p <br />Notary Public <br />County of Residence Marshall w_w <br />Version 1/17/2019 Contractor's Bid for Public Works - 6 <br />