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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 23rd day of Nov. , 20 21 <br />Subscribed and sworn to before me this 23rd <br />My Commission Expires <br />2/2/2024 <br />County of Residence <br />Donald Ritschard, Jr., Vice President <br />Printed Name and Title <br />d y of November 20 21 <br />(1 -6 � v �D v k - <br />Notary Public \``,1111Iffill, <br />�� <br />St. Joseph <br />N�. A�BLIG <br />�Q <br />OF INS\P �`•• <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />