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may result in forfeiture of contractual payments. <br />*M* <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 />Dates this. ! day of Miz1 , 20 <br />Con actorBidder (Firm) <br />Signature ontractor/Bidder orig Agent <br />Subscribed and sworn to before me this Z 7 <br />My Commission Expires 7LAI)t' 23 i ZOZ,7 <br />County of Residence <br />Printed Name and Title <br />day of 0A U a�, , 20 �.S <br />Notary Public <br />S+ -)- oswe N <br />CHRISTEN HOLLENBACH <br />Notary Public - Seal <br />St Joseph County • State of Indiana <br />Commission Number NP0727545 <br />My Commission Expires Jun 23, 2028 <br />