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Part of State Form 52414 (R212-13) 1 Form 96 (Revised 2013) <br />FO-RD-110-M <br />I,wn, nowwraira <br />(Contractor) <br />PO Box 428 <br />(Address) <br />Ashley, IN 46705 <br />FOR <br />PUBLIC WORKS PROJECTS <br />1011 <br />City of South Bend <br />Filed <br />Action taken <br />