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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 />a <br />Dated this day of _� 0 <br />Contractor/Bidder (Firm) <br />m <br />Signaltire of Contractor/Bidder or Its Agent <br />yam r C% <br />Printed _� e an�._. .._w../.-� <br />—� <br />Title <br />Subscribed and sworn to before me this day of 20 a0 1 <br />My Commission Expires ... _ ... <br />1 1 ° ry Public <br />Countyof Residence .._- "_� .........._�._ �...w__.....�.._....._�m......� �.�,..,m.......................... <br />7-7 . <br />61 <br />Version 8 — 02/25/14 <br />