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may result in forfeiture of contractual payments. <br />a.x <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 Y +h day of DEC,, 20OLI <br />PREMIUM CONCRETE SERUYCES <br />C9utrast rBic er (F' h <br />i <br />Signature of on ract r/Bidder or is Agent <br />Printed Name and Title I j <br />Subscribed and sworn to before me this day off—,, 20� <br />My Commission Expires a o�iD ti ! Q 1' dlXa3Y� <br />Not ry Public <br />County of Residence ��N A P�r <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELKHART COUNTY, STATE OF wt sib,v <br />MY COMMISSION EXPIRES FEBRUn <br />COMMISSION NO.7109(4! <br />JANEE M TOWNER <br />NOTARY PUBLIC <br />SEAL <br />ELWART COUNTY, STATE OF INDIANA <br />COMMISSION EXPIRES FEBRUARY 12, i <br />COMMISSION N0.710399 <br />Version 09/29/2024 Contractor's Bid for Public Works - 6 <br />