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may result in fimfeiture ofcoNjjarac#�raq <br />EM <br />I hereby affirm tinder the lwnallies of perjury that the Cacks and infogamfion contained in the foregoing bid <br />for public works are Ifix and cosireq. <br />Datcd this ­ 0 /--. d;ay oft '-A1G, 201:7 <br />j s <br />taorlltigtrut <br />-IF <br />ai i� /Bidder or Oils A, <br />//CIL <br />I Nam= andTille <br />0 k <br />Subscrik-xd and sworn w bef6re aw, I�Ijs Z_ I day of`D_QP_-tffl�)QV_ 20 <br />Aff <br />Nab[y Public <br />County of Residence <br />traiq Mamela Galvan 4 <br />'a <br />rl <br />Notary Pubkc SeW Statc, of Indiana <br />St. Joseph County 7,12 1 i5 <br />Commission A 702616 <br />6 <br />My 0 16 0 <br />My Commission Expi(es 07116t2O2.6 <br />F�� lOcAoylrm <br />Version 1011712016 OMIlkWtOf'S Dd lbr Public Wcfks ­ 5 <br />