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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 2 6 t h day ofNoyemkmjxp, 2019 <br />Larson <br />LARSON DANIELSON <br />00 SEAL, CONSTRUCTION CO,, INC, <br />JILww� <br />Danielson Const. Co., Inc. <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />Timothy F. Larson, President <br />Printed Name and Title <br />26th <br />Subscribed and sworn to before me this day of November, 2019 <br />My Commission Expires <br />9/8/23 <br />County of Residence <br />Notary Public Michele ". Dzielinski <br />LaPorte <br />�.10.CN�wNgvNOU,�na�N� <br />WOHELE dcELIA DIIEL INSKI <br />r �p��u�uNroi+c�uw�,m�m03 uwwm�mr✓"m��°wr <br />i y rot siowi Expires <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />