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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 28th day of March , 2023 <br />Subscribed and sworn to before me this 28th <br />My Commission Expires <br />6/5/2030 <br />County of Residence <br />M <br />(Firm) <br />of Contractor/Bidder or Its Agent <br />Dustin P. Hilary, Director of Estimating <br />Printed Name and Title <br />day of March , 20 23 <br />C <br />Notary Public - Alisha Krueg <br />LaPorte <br />"'..iP;; <br />ALISHAKRUEGER <br />` <br />-' SEAL = <br />June�S, Zp3p <br />9 P2l• <br />^-�.. -- �PMC'C,. <br />(j01r1nftionHumberNP0653544 <br />Le Polb Coungr <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />