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may result in forfeiture of contractual payments. <br />**r <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 r 3P day of _R&, 20 a1 <br />�(LC=rKxupl GvnkJZf7��RUrcL`5 TNt <br />Contractor/Bidder (Firm) <br />Signature of Contractor/Bidder or Its Agent <br />�o6 65rxm,� 7�d crl .W,46—,4 <br />Printed Name and Title <br />RD <br />Subscribed and sworn to before me this a3 day of 20y2( <br />My Commission Expires bd , <br />NoJay Public <br />County of Residence El-i�iA� <br />J O <br />NOTARY PUBLIC <br />R <br />SEAL <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, f <br />COMMISSION NO.710399 <br />Version 01/13/2021 Contractor's Bid for Public Works - 6 <br />