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may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of perjure that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this LU da\ of V 2075- <br />ContractorBidder (Firm) <br />a� <br />S gent <br />Printed Name and Title <br />Subscribed and sworn to before me this t-y day of t ' l 20 <br />My Commission Expires <br />No b c <br />,ORA QI,,' County° of Residence • �(� 5 <br />-; c�j •-OV ARY' 99''s <br />40 <br />4 C iss on <br />Np075 g5p5 <br />- <br />;MY C°mrn•26 1 <br />A G • Q' <br />�r'4 !°UBI—. �41 <br />' •ate <br />OF <br />'#Ili4a 1t 00 <br />Version 1/3/2025 Contractor's Bid for Public Works - 6 <br />