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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 h.._,__....._,_.,,,. day of Nov. 12019 <br />of Contractor/Bidder or Its Agent <br />Dustin HHW Y ofIT outhl. Bend Area <br />Printed Name and Title <br />Subscribed and sworn to before me this 26th day of rn g eer 2019 <br />My Commission Expires _ 6/5/22 <br />....................... _....... _. Notary tibiia�.. __.m. Alisua Krueger <br />County of Residence St. Joseph <br />ALISHA KRUEGERtary <br />Public, Stateof krw�tlsn's <br />=01�r <br />St„ Joseph CountyMy <br />Commission Expires2022 <br />June05w <br />Version 4/2/2019 Contractor's Bid for Public Works - 6 <br />