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may result in forfeiture of contractual payments. <br />I hereby affinn 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 20 <br />(F <br />Signature of Contractor/J,,id&For Its Agent <br />1"Y <br />v- <br />Printed Name and Title <br />Subscribed and sworn to before me this day of 20AY <br />6-11 MI ",I — , A 11 y Commission Expires AM4 <br />L — ) � <br />N6iiiy Public <br />County of Residence <br />III � P I J�fjjl�' "s <br />S <br />TE"I"OF <br />11401ARY <br />4 <br />Q'Im, kol <br />o�l Exvl, I - <br />Version 10/1'7/2016 Contractor's Bid for Public Works - 6 <br />