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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 12th day of Dec. , 2017 <br />S��GG�3u;N�N <br />yLb J <br />�p1;P Q RA <br />° <br />a <br />� a o <br />a! a F, ^� <br />1 <br />H. <br />of Contractor/Bidder or Its Agent <br />Hilarv. South Bend Area <br />Name and Title <br />` Subscribed and sworn to before me this 12th day of December 20 17 <br />My Commission Expires 615122 <br />Notarylru'bfil Alisha Krueger <br />County of Residence St. Joseph <br />,\�tirttYlprr��� ALISHA KRUEGER <br />Notary Public, State of Indiana <br />St. Josoph county <br />'-;�;•...� My Commission Expires <br />ltAttt��' JuneO6 2022 <br />Version 10/17/2016 Contractor's Bid for Public Worsts - 6 <br />