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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 />14 <br />Dated this .11 day of d IQ q , 20 d,3 <br />/ContractoBidder (Fif Contractor/Bidder o is Agent <br />Z%sj ` nCa i\A <br />Printed Name and Title <br />`/� '✓ <br />Subscribed and sworn to before me this Vnday of.... <br />i' I 20� <br />j� <br />, <br />My Commission Expires LU++, �f y 10 Loll <br />oll / Ov <br />Notary Public <br />County of Residence I � C iI I/A (/inn S <br />ALICIA J MOSS <br />M Notary Publit <br />a o State of Ohio <br />ae o My Comm. Expires <br />October 10, 2027 <br />Y <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />