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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 22nd day ofOctobe,rZp 24 <br />Larson -Danielson Construction Company, Inc. <br />Contractor/Bidder (Fi ) <br />LARSON-DANIELSON <br />IS <br />CONSTRUCTION CO., INC. X <br />Signature of Contractor Bidder or Its Agent <br />Brian T. Larson, President <br />Printed Name and Title <br />Subscribed and sworn to before me this 2 2 nd day of October 52024 <br />Ily g Eby MCH D ak <br />Michele Dzielins INN -US, E='mctl�ldcons4udbn,. om CN=Mk ele <br />My Commission Expires 9 / 8 / 31 X 20 4,g�g„� <br />Notary Public Michele C. Dzielinski <br />County of Residence LaPorte <br />MICHELE CECELM OZIF3NSKI <br />C_ 2WI <br />SpWriar8,Wf <br />�'., �+; �= Camisml� HPo6iN13 <br />Version 03/15/2024 Contractor's Bid for Public Works - 6 <br />