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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 10thIT day ofDecembei20 19 <br />Selge Construction Co., Inc. <br />Contractor/Bidder (Firm) <br />....... ............... <br />Signature of Contractor/Bidder or Its Agent <br />-PgbgWM,- gineer <br />Printed Name and Title <br />Subscribed and sworn to before me this 10th;'day of Decembex 0 <br />My Commission Expires 07/25/2020 f <br />7 <br />Notary Public <br />County of Residence . <br />e"i <br />M PUBLIC <br />IVlY CQRhMI�SIESRI �'„ <br />EXPIRES f � <br />7-2 a, 2020 <br />MIS` 0 <br />ty,�°�'rPaa rM tuw u r <br />Version 10/17/2017 Contractor's Bid for Public Works - 6 <br />