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Part of State Form 52414 (R212-13) / Form 96 (Revised 2013) <br />i <br />Bit -Mat Products of Indiana <br />PO Box 428 <br />Ashley, 1N 46705 <br />FOR <br />(contractor) <br />PUBLIC WORKS PROJECTS <br />OF <br />City of South Bend <br />Filed <br />Action taken <br />(Address) <br />