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(ix) ✓ Written statement of any federal, state or local tax liens or tax delinquencies owed <br />to any federal, state or local taxing body in the preceding three years. <br />(i) 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:�P(:;,( 7 <br />C5�2� <br />CHere) <br />r c L <br />(Print Name Here) ] <br />(Name of Company) <br />(Address of Company) <br />F4;t /Je <br />(City) <br />K �/ 171CAl r1f <br />(State) <br />S6��, 1 a i-- qo©i <br />(Telephone Number) <br />Version 07/19/2023 General Conditions - 15 <br />