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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 q day of 20-4- <br />Contractor/Bidder (Firm) <br />Signature of Co ltractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this qt-` day of Its n 20 -i ( <br />My Commission Expires I I " 2 l - 2031 <br />County of Residence <br />jED <br />NoPublicdiana <br />Elknart C <br />Commissi52954 <br />My Co nmio21; 2011 <br />Qta Public <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />