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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 9th day of May 20,23 <br />Subscribed and sworn to before me this 9th <br />My Commission Expires 10/27/2027 <br />County of Residence <br />Selge Construction Co., Inc. <br />Contractor/Bidder {Firm} <br />%gnature of Contractor/Bidder or Its Agent <br />Justin Butler, Vice President <br />Printed Name and Title <br />of May , 20 23 <br />1107451 <br />Berrien <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />