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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 TWA. .......... ....._ day of r b 20 20 <br />o ko kx IVI A S a rim_!!`, ._._....._.. <br />Aonfi,,a,)r/Bidder (Firm) <br />:. Notary Public of CoMOLLY M BELLE ANTE�' ,retractor/Bidder or Its Agent <br />,01 AAt dVll coup of p, . <br />end the sit of Indiana // <br />° ssion lVt�rnG r l Pp 1 70 9 k% 13 G /�o r" <br />___ _ <br />yCOM nlssion Expires loll?/, 0 Prince Name and Title <br />c ` kbrndr <br />Subscribed and sworn to before me this "39 day of A:,e� _ 20_—�O <br />M Commission Expires `" "ti <br />�,.]'NotY P <br />County of Residence <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />