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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 20th <br />Subscribed and <br />My Commission Expires <br />day ofDecember2018 <br />Michiana Contracting, Inc <br />Contractor/Bidder (Fiat <br />Signature of Contr ctor/Bidder or Its Agent <br />Scott Kirkpatrick, President <br />Printed Name and Title <br />to lr f re me this 20tii lay of December m 20 <br />Notary ;Ipuflic <br />County of Residence <br />PAMELA SINGLETON <br />Seal <br />Notary public - Slate of Indiana <br />Starke County <br />My Commission Expires Apr 2, 2025 <br />a <br />