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mayresultinforfeitureofcontractualpayments.Iherebyaffirmunderthepenaltiesofpeijutythatthefactsandinformationcontainedintheforegoingbidforpublicworksaretrueandcorrect.Datedthis_________dayof______01aLR(LAqft1xContractor/Bidder(Firm5ctSigzattIeofContractor/BidderorItsAgentcccLAfflyrPuntedNameandTitleSubscflbcdandsworntobeforemethisMyConmiissionExpiresto(iiJzozCountyofResidence____ciavof(oy’c.2o2Y/a%enanNotyPublicLqk4,\•NOTARYP(j;SF4.tPs