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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 }�l 1 h day of202�, <br />Contractor/Bidder (Firm) <br />Signat of ontrac or/Bidder or Its Agent <br />M0-)Ot eu - ykeyms\den� <br />Printed Name -H d Titleli <br />Subscribed and sworn to before me this 1Q day of M 36(h .20 -2(0 <br />My Commission Expires t <br />IAA�94 4kt- <br />Notary Public <br />Countv of Residence E Mh@ 4 <br />KELSEY MARIE STONE <br />Notary Public <br />Elkhart County - State of Indiana <br />Commission Number NP0765931 <br />My Commission Expires Sep 17, 2033 <br />Version 5/20/2024 Contractor's Bid for Public Works - 6 <br />