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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 X day of C; 20 > <br />Cont for/Bidder LEiirnl <br />Signature of Contractor/Bidder or Its Agent <br />A4T,gicAl- 16-1215KIV 7–.z —7 <br />Printed Name and Title <br />Subscribed and sworn to before me this day of Dt. C , 20,-,')/ <br />My Commission Expires 11,211619 Z/i%' <br />Notary zutric <br />County of Residence <br />Hj�RRY P SEtktt:LETON <br />^Sc�tarY F.It, iir S 3 sIi 01 i'.6ana <br />�- t ,c r C,cin.y <br />a <br />c=+anas5iur, 67L554 <br />t9Y r, ITr��17 4 .ton ExpirCS <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />