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may result in forfeiture of contractual payments. <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 />Dated this a f 4h day of / 1 , 20 oC' <br />Signafure of Contractor/Bidder or s Agent <br />,00 <br />Printed Name and Title <br />Subscribed and sworn to before me this 1%*v\ day of — 20 <br />My Commission Expires <br />otary Public <br />County of Residence <br />JAMESBRAAT7 <br />Notary Public • Seal <br />Elkhart County - State of Indiana <br />Commission Number NP0752954 <br />My Commission Expires Nov 21, 2031 <br />Version 07/19/2023 Contractor's Bid for Public Works - 6 <br />