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may result in forfeiture of contractual payments. <br />1 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 �wCA 20Z <br />k L 1'"" & I gX) <br />'t,�s <br />Contractor/Bidder (Firm <br />on actorATMer or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this `7 day of t , 20a7 <br />/ 1 <br />My Commission Expires f �l /Z q <br />Notary Public <br />County of Residence & o <br />Official Seal <br />SUSAN MARIE HINZ <br />Notary Public, State of Illinois <br />Commission No. 100247 <br />My Commission Expires October 16, 2029 <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />