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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 25th day of June 2019 <br />LARSON DANIELSON <br />CONSTRUCTION CO,, INC. <br />µ <br />Larson Danielson <br />Construction Co., Inc, <br />Contractor/Bidder (Firm) <br />X _ <br />Signature of Contractt),/ dder or Its Agent <br />Timothy F. Larson, President <br />Printed Name and Title <br />Subscribed and sworn to before me this 2 5 t h day of June , 20 19 <br />My Commission Expires <br />9/8/23 <br />County of Residence <br />Notary Public Mi c h e_ C. D z i e l i n s k i <br />LaPorte <br />— <br />MICHELE CECELIA DZIELINSKI <br />La Porte County <br />® �r <br />My Commission Expires <br />W o @a�'rp�rc�r B, 23 <br />Version 1/17/2019 Contractor's Bid for Public Works - 6 <br />