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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 IU"- day of 2023 , <br />CI L t--XC&j6-h Kr I rc . <br />Contractor/B' (Firm) <br />Sign ure of Contractor/Bidder or Its Agent <br />fS! �rc�r dam' <br />Printed Name and Title <br />Subscribed and sworn to before me this �V _ y of C L , 2023 <br />My Commission Expires ZD 2 <br />Notary Public <br />County of Residence 13 UYAY+ <br />�a"Y r CRISTOL MELODY VALDEZ <br />bEAR... �p`'.� Notary Public, State of Indiana <br />'o' Elkhart County <br />=z SEAL;" Commission # 696906 <br />,� , .. •y,1�: My Commission 5 <br />'n,Mp ��`'�•� February 2 0 2025 <br />Version 09/29/2021 Contractors Bid for Public Works - 6 <br />