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may result in forfeiture of contractual payments. <br />T 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 24th day of Nov. 12020 <br />wv - Ziolkowski Construction. Inc. <br />r Contractor/Bidder (Finn) <br />cO SGQ�lag1�°,tY tOLGC tC1 /1D7 <br />Signature of Contractor/Bidder or Its Agent <br />SEAL C) <br />Bill Favors. President <br />a .nq Printed Name and Title <br />Subscribed and sworn to before me this 24th day of November ?020 <br />My Commission Expires January 28. 2023 <br />No ry Public <br />County of Residence <br />JENNIFER WIEST <br />2L Notary public, State of Indiana <br />St. Jbaaph County <br />$ SEA ;' ` <br />a <br />Cbmmlatllon N 663340. <br />My commlulon Eepiru <br />I..., <br />unlna" <br />��� <br />January 28. 2023 <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />