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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 _ day of 20,0 <br />Subscribed and sworn to before me this <br />My Commission Expires �2 0 3D <br />\pNG NoTq'�, <br />9 <br />ounty of Residence <br />W � <br />rep: JAN <br />of Contractor/Bidder orAgent <br />Printed Name and Title <br />da of n I' (k f , 20_!�5 <br />Notary Public <br />?uS&49A-IJAS <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />