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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 of , 20__ <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this day of , 20 <br />My Commission Expires <br />Notary Public <br />County of Residence <br /> <br />