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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 CA day of fO- b <br />Subscribed and sworn to before me this <br />My Commission Expires 0211s %�-2 5 <br />®``glllllid/��rg <br />o p gi: (ni • 77b• <br />'s CA :�� LBLt�' ••' Q` <br />I <br />� s r <br />••9�;gRY 5 , ZOO;.• ¢C% <br />O <br />aes,-' A1T Y,tO <br />ContractorBidder (Firm) <br />14 //11(1// 1 <br />Signature of Con`� V <br />t�r for/Bidderor Its Agent <br />'Do Y;'cl ! Y 14 ; P <br />Printed Name and Title <br />day of �� O i'l. 20 23 <br />Notary Public <br />County of Residence C D&O, c ou r—,V±�J, <br />1/—inn C`nnf—fnr'e Rir! fnr M iKlir Mh—lrc - R <br />