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play result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of petjuty that the facts and information contained in the forcgoing bid <br />for public works are true and correct. <br />Dated this " day of Fri , 20+- <br />Contract /Bidder (Firm) <br />Si nature of Co actor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before the this /02- clay of <br />MY Conunission Expires � ' c3 � �� � O <br />Notary Public <br />County of Residence - p� <br />Et�,,,v <br />ROXANNELAURENEALFORD <br />Notary Public, State of IndianaEAL "- St. Joseph County <br />Commission Number NP0741624 <br />My Commission Expiresnm"`� May 31, 2030 <br />