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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, n <br />gbh day of Ilui7,,2013 <br />Dated this <br />in1Uc�CbI�P. ► KVICES 1 rJC., <br />Contractor/Bidder (Firm) <br />signature of Contractor/Bidder or Its Agent <br />ft)(yEAKV J. tom. <br />Printed Name and Title <br />Subscribed and sworn to before me this b * day of <br />My Commission Expires ��- <br />County of Residence <br />N ary Public <br />JANEEMTOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COUNTY, 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 />