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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 o 20 <br />C_, <br />Contractor/Bidder Firm <br />Signature of Contractor/I,3addei• r Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this C( day of a1,1U6, &:mm , 20�.J <br />. �. <br />My Commission Expires ......��...1..D'w a .. <br />Notary Public <br />� _ <br />County of Residence <br />TARA R. EDWARDS <br />NOTARY PUBLIC <br />SEAL <br />STATE OF INDIANA <br />MY COMMISSION EXPIRES JAN. 20, 2025 <br />