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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 ),I , J day of , 20 a( <br />Contract i er (Fiz <br />t._ <br />Signature ;f &6ntractor/BjAder or Its Agent <br />1 /oV' JC /G 0,( / J, f <br />Printed Name and Title <br />Subscribed and sworn to before me this n� day f H OV <br />20 <br />My Commission Expires I <br />Notary Public <br />County of Residence [1404 <br />Heaven Edwards <br />Notary Public Seal State of Indiana <br />Elkhart County <br />(;ornmission Numbe es 03125 79 <br />779 <br />My^,ommission Expires <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />