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may result in forfeiture of contractual payments. <br />xx� <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. Dated this �_ day of _ 1 ' /y� tint-, 20a_3 <br />1+'E lu m�o�JCR CTE SERU I YN C <br />Contractor/Bidder (Firm) <br />Signature of Contract r/Bidder or Its Agent <br />MAXy AKCY V.P- <br />Printed Name and Title <br />Subscribed and sworn to before me this i5 day of <br />�a My Connnission Expires 11 a0a�0 �t Not y Public <br />c <br />County of Residence Fi-KN APT <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />ELKHART COUSEAL <br />NTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION NO.710399 <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />