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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 2 5 t h day of June 2019 <br />LARSON DANIELSON <br />SEAL, ' CONSTRUCTION INC. <br />CONSTR N CO <br />Larson Danielson <br />Construction Co., Inc. <br />Contractor/Bidder (Firm) <br />X <br />Signature of Contractor/II idder 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 />9/8/23_.- <br />My Commission Expires `" " <br />NotaryPublic Miche C. Dzielinski <br />County of Residence LaPorte <br />^,; d MICHELE CECELIA DZIELINSKI <br />La Porte County <br />My Commission Expires <br />SOiXm:.nryIX''8,2023 <br />Version 1/17/2019 Contractor's Bid for Public Works - 6 <br />