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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 1 1th day of Dec. 20 18 <br />,LLY, q <br />.. ........ <br />C,3�,NT E <br />CO <br />% <br />Subscribed and sworn to before me this 11th <br />My Commission Expires 6/5122 <br />County of Residence <br />SiWRturc of ContraFtor/Ridder or Its Agent <br />Dustin Hila , VP of S�outh Bend Area <br />Printed Name and Title <br />. day of December 2018 <br />i4� t9 644,11- <br />Alis Krueger <br />St. JoseDh <br />ALISHA KRUEGE R <br />�9 NotarY Public, state of in-J13! <br />st, Jos p h C 0 J r. TV <br />Mv Corn, ision Exp,ro5 <br />JuneQ5,2022 <br />a -**-- <br />Version 7/20/2018 Contractor's Bid for Public Works - 6 <br />