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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 Q1 day of bW(1 0 27- 5 <br />C j-am C, �CI� 11 l' v� tz r �1 g �'i I ✓1 <br />Contractor/Bidder <br />6,/'s6nkture of Contractor/Bidder or Its Agent <br />Mo,tvC�he - f�,rec �,Ca,� 101 Sad s <br />Printed Name and Title <br />Subscribed and sworn to before me this 2 S� day of - '2- <br />21 <br />L <br />20 Z <br />S �'` Shely Parn ss <br />My Commission Expires C <br />Notary Public g COI,} ''!�R A <br />County of Residence e Wc� <br />Version 8 — 02/25/14 <br />