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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 <br />S Aric- <br />r/Bi {F-i <br />Signature o ontractor • -/Bidde or Its Agent <br />Rva -L �, - b � , ��e � <br />Printed Name and Title <br />Subscribed and sworn to before me this day of /! Ir A <br />M Commission Expires VIP Z/ � 2,7 <br />"��� <br />y ublic <br />County of Residence �. <br />p P\\PYP JARED HOLST <br />Notary Public, State of Indiana <br />"z SEAL"'= St Joseph County <br />*'. *4 Commission Number NP0724085 i'•.... <br />My Commission Expires <br />December 12, 2027 <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />