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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 %Q+� day of -4 4oly, 20zz <br />rem, -<o,,. Wo%+,erL. at,i 5 <br />ConBidder (Firm) <br />Signature o Contractor/Eidder or Its Agent <br />F�Qv%v\ 11Jju r — ezmi c:-% (MGrnN� ('- <br />Printed Name and Title <br />Subscribed and sworn to before me this J D* day ofJ�'�/ �A, /'20� <br />My Commission Expires D l I a� zq ,I Q A,AL l7 kt46,tWLaA <br />Notary Public <br />County of Residence S-E-�� <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />