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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 ... _...... day of <br />Contractor/Bidder (Firm <br />Sign.. tt -e of C,'ol tractor/Bidder or Its A gent <br />:k,,"t— <br />Printed Name and Title <br />Subscribed and sworn to before me this _ ...6 de <br />day of J <br />My Commission Expires l �� �i <br />� ry LI lie <br />County of Residence <br />�, rr ✓�rs, �-..�„✓'�+'r✓'.N.N.ar=:rrr.�"�✓.r".v»�"..r,,,e".✓^ :;�"M✓✓`�V <br />