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may result in forfeiture of contractual payments. <br />*r* <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 a4k day oQQ , 20al <br />�.Efnlumrs�►yc.R� i ESV ic��S, 7►�c . <br />Contractor/Bidder (Firm) <br />Signature offfContractor/Bidder or Its Agent <br />fWalo gs We ,mclr . <br />Printed Name and Title <br />Subscribed and sworn to before me this 'a�1 day of JUuw , 20 <br />My Comtnission Expires ba a C)P-%-LL <br />Noilky Public <br />County of Residence CLMAP—T <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO. 710399 <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />