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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 12th day ofSeptembeQ023 <br />S <br />LARSON-DANIELSON <br />CONSTRUCTION CO., INC. <br />Subscribed and sworn to before me this 12th <br />My Commission Expires <br />9/8/31 <br />County of Residence <br />Larson -Danielson Construction Company, Inc. <br />Contractor/Bidder (Fi ) <br />X <br />Lz — <br />Signature of Contractor7bidder or Its Agent <br />Brian T. Larson, President <br />Printed Name and Title <br />day of September , 20 23 <br />Notary Public <br />Michele C. Dzielinski <br />LaPorte <br />stP_� CARBON-DANIELSON <br />�me e <br />`..SEAL. CONSTRUCTION CO., INC. <br />%wawa <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />