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may result in forfeiture of contractual payments. <br />I hereby affn-m 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 day of N20 ' <br />i,6js�L�J1i LJ:,,j�fY�G 1M ✓�Gl1�i J <br />Contractor/Bidder (Firm) <br />C�� <br />Signature of Contractor/Bidder or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this day of <br />My Commission Expires <br />Notary Public <br />FRF�''•.ti�. <br />�• QP .`��� # KYN,o�Cy <br />a <br />2° aoTARy�� <br />y : c AVBO CY <br />,y�, • • . P• • �� <br />�''�•. 4gRGE,� <br />''''�uuu uw►a•►• <br />County of Residence 14all) I <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />