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I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing <br /> pre-qualification proposal for public works are true and correct. <br /> Dated this day of , 20 <br /> Contractor/Bidder(Firm) <br /> Signature of Contractor/Bidder or Its Agent <br /> Printed Name and Title <br /> Subscribed and sworn to before me this day of , 20_ <br /> My Commission Expires <br /> Notary Public <br /> County of Residence <br /> 23 <br />