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may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of perjury that the Man information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this 12th day of Sept. 20 23 <br />Premium Concrete Services Inc. <br />Contractor/Bidder (F' n) <br />Signature o Contractor/Bidder or Its Agent <br />Max Yeakey, Vice President <br />nted Name and Title <br />Pri <br />Subscribed and sworn to before me this I �* day or PT 20 a3 <br />My Commission Expires 1� <br />Nc ary Public <br />I.. County of Residence Lkgfi a <br />J NOTARYU BLIOR <br />SEAL <br />ELKHART COUNTY, STATE OF INDIANA <br />MY COMMISSION EXPIRES FEBRUARY 12, 2026 <br />COMMISSION N0.710399 <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />