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<br /> <br />Version 09/29/2021 Contractor’s Bid for Public Works - 6 <br />may result in forfeiture of contractual payments. <br />*** <br /> <br /> <br /> <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 /> <br />Dated this day of , 20__ <br /> <br /> <br /> Contractor/Bidder (Firm) <br /> <br /> <br /> Signature of Contractor/Bidder or Its Agent <br /> <br /> <br /> Printed Name and Title <br /> <br /> <br /> <br /> Subscribed and sworn to before me this day of , 20 <br /> <br />My Commission Expires <br /> Notary Public <br /> <br /> County of Residence <br />12th September 23 <br />Larson-Danielson Construction Company, Inc. <br />X <br />Brian T. Larson, President <br />12th September 23 <br />9/8/31 X <br />Michele C. Dzielinski <br />LaPorte <br />LARSON-DANIELSON <br />CONSTRUCTION CO., INC. <br />S T A TE OF <br />INDIA AN <br />SEAL <br />C or porate <br />LARSON-DANIELSON <br />CONSTRUCTION CO., INC. <br />S T A T E OF <br />INDIA AN <br />SEAL <br />C or porate