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NUMTRO 7FAM-PIN7AX7.07) ultvj <br />forfeiture of contractual payments. <br />I hereby affirm under the penalties ofpedury that the facts and information contained in the foregoing bid for public <br />works are true and correct. <br />Dated this 6 th day of May .20 19 tA L' Q WC, kcr <br />CA <br />Con t r/Bidder (Fj <br />Signature of Cantmctor/Bi der or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this U� day of c 20 kq <br />MY Commission Expire <br />-�y Public <br />41,114111 Notary Public <br />P <br />OS� <br />(P <br />"s< 0� <br />'Otis $w III <br />County of Residence <br />Vemlon IMM2019 Page - 10 Public Waits Quote <br />