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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 11th day of July , 2017 <br />......•..• <br />:• fORP Z= <br />C7 <br />Y <br />s,00DIAN N0a�`�°. <br />of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this �11th _ day of _,___Jul , 20 <br />1 <br />My Commission Expires 6/5122 _ <br />Notary Public Alisha Krueger <br />County of Residence St. Joseph <br />Version 3/2012017 <br />Contractor's Bid for Public Works - 6 <br />KRUEGER <br />usuirrrr�ALISHA <br />?;� tie��: Notary Public, State of indiens <br />= ;5E Al ; * w <br />st, Joseph County <br />* <br />µy Commission Expiree022 <br />