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may result in forfeiture of contractual payments, *** <br />I hereby affirm tinder the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are true and con-ect. <br />Dated this 19th day OfD!cembepO17 <br />Michiana Contracting, Inc <br />Contra r/Bidder F" -m <br />on <br />ip tr or/B i der or I SignatureofContra or/Bi derorltsAgent <br />Scott Kirkpatrick President <br />Printed Name and Title <br />Subscribed and sworn to before me this 19th day of December 17 <br />My Commission Expires <br />ary Public <br />County of Residence Marshall <br />Version 10/17/2017 Contractor's Bld for Public Works - 6 Addendum #1 <br />