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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 _;a M day of MAU 20.0 <br />�.EIh1UMlD►J FT r�Vl (`kms 11JG- <br />Co�n_acto <br />trraactto�r/Bidder (Firm) <br />Signature-7PContractorBidder or Its Agent <br />1+ AYy1=AVEy 0lJn1IEP. <br />Printed Name and Title <br />Subscribed and sworn to before me this nd day of I' A f -C" 20 - o <br />My Commission Expires.0 QRLk -m .off <br />N tary Publiic� <br />County of Residence E� k At, -I <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />EIKHART COUNTY, STATE OF INDIANA <br />MW COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMlISSION NO. 710399 <br />Version 08/25/2021 Contractor's Bid for Public Works - 6 <br />