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Ox) Writteir staternent Many tederal, sit�ate or local tax fiens or tax delinquencles owed <br />to any federal,, state or local taxkig body in the preceding three years. <br />(1) List of projects of similar size and scope of work performed in all areas, including <br />the State of Indiana, within three (3) years prior to the date on which the bid is due, <br />Date:, August 26, 2019 <br />.......... <br />. . ......... . <br />(Sign Here) <br />Marita Kreps <br />(print me —Here <br />Brown & Brown General Contractors, Inc. <br />(Name of Company) <br />124 S. Elkhart St., PO Box 487 <br />(Address of Company) <br />Wakarusa <br />(CRY) <br />IN <br />(State) <br />574-862-2171 <br />(Telephone Number) <br />Version 5/16/2019 General Conditions - 10 <br />