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violations hereunder 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 December _ day of 10 , 2019 <br />North , Indiana f etlt trt etion n any Inc. .IT, <br />Cc race r/Bid ( 7irin) <br />01 <br />Signature of C i ractorBidder or Its Agent <br />David J. Walorski President <br />Printed Name and Title <br />Subscribed and swornto before me this 10th d� " Decer Iict r� 10 m 19� <br />My Commission Expires April 16, 2025 /—U44A -Z �11 <br />Notary Public Danisha'L. Marabie <br />County of Residence St. Joseph <br />Version 1/17/2019 Contractor's Bid for Public Works - 6 <br />