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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 22nd day of Sept. , 20 20 <br />,M9,il <br />Ziolkowsld Construction, Inc. <br />Contractor/Bidder (Firm) <br />N <br />,r�' <br />of�„,'��M„e�,^`w AIM <br />� <br />,emu <br />""" <br />J* <br />,dp <br />w <br />Signature of Contractor/Bidder or Its agent <br />m, <br />SEALr' <br />n <br />Hill Favors President <br />Printed Name and. Title <br />Subscribed and sworn to before me this <br />22nd ay of , e to ber, ,� 2 20 <br />y Commission Expires ;January 28. 2023 <br />� ` <br />w� � � b d <br />otary PUN ic <br />County of Residence St. Joseph. <br />fVwaiV Public, Sate of Indiana <br />�y <br />t, JOSeph C ounYy <br />conirnission fl 66,1344 <br />MN d oivnii .9ion Expire.-9 <br />St 1.k°y <br />Jorluafy 28, 2023 <br />:�id1'ti'1dm,S?�; '. fiml�CtCW'�CRCC��"%WOVNr�.M�"9h�i°Wl'Mi. , <br />Version 4/2/2019 Contractor's laid for Public Works - 6 <br />