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(ix) _� Written statement of any federal, state or local tax liens or tax delinquencies owed <br />to any federal, state or local taxing body in the preceding three years. <br />(i) ✓ List of protects of similar size and scope of work performed in all areas, including <br />the State of Indiana, within three (3) years prior to the date on which the bid is due. <br />Date: <br />(Sign Here) /I - <br />U <br />cc✓ K ,5 /e, <br />(Print Name Here) J / <br />Jz %J'Ji O" 4 <br />(Name of Company) <br />(Address of Company) <br />y s,—e.�l� <br />(City) <br />(State) <br />(Telephone Number) <br />Version 08/25/2021 General Conditions - 10 <br />