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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 />Dated this C Cy iA day of 20�� <br />Sigfiature of Contractor/Biddg--di Its Agent <br />Ad D ri <br />Printed Name and title <br />/ A <br />Subscribed and sworn to before me this W( day of DIl'C/1 , 20AQ& <br />My Commission Expires I I� <br />- 21 - 2-0'3 1 <br />County of Residence <br />ary Public <br />ElKho"'C � <br />JAMES BRAATL <br />Notary Public - Seal <br />Elkhart County - State of Indiana <br />Commission Number NP0752954 <br />My Commission Expires Nov 21, 2�] <br />031 <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />