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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 />ILI <br />Dated this �- day of&L, 20 A I <br />,6-� (� QOVAT �, 4\ w� <br />Co tractor/Bi e ) <br />11tw <br />Signature of Contractor/Bi der or s Agen <br />Printed Name and Title <br />Subscribed and sworn to before me this day of Gil , 20 <br />My Commission Expires C41 <br />r�0 31 <br />County of Residence <br />Notary Public <br />LI Q <br />BILLIE BRUNN <br />Notary Public - Seal <br />St Joseph County - State of Indiana <br />Commission Number NP0750610 <br />My Commission Expires Aug 3, 2031 <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />