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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 1 / , 20 ,U— <br />/"C /' tc,Sa�I �it%G� Tcr tyr�r CGS <br />Cnntracder�Fi � --- <br />Signature of ContractoriTidder or Its Agent <br />6�a L <br />Printed Name and Title <br />Subscribed and sworn to before me this day of 112A , 20� <br />My Commission Expires F • c--), "V 5 <br />Notary Public <br />County of Residence <br />ADELITA MEDINA <br />Notary Public <br />St Joseph County - State of Indiana <br />Commission Number NP0758589 <br />My Commission Expires Sep 3, 2032 <br />Version 07119/2023 Contractor's Bid for Public Works - 6 <br />