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RETURN WITH BID <br /> ' Illinois Department <br /> of Transportation Affidavit of Illinois Business Office <br /> County Macon <br /> Local Public Agency City of Decatur <br /> Section Number 21-00111-00-RP <br /> ' Route Various Streets <br /> State of <br /> ' <br /> ) SS. <br /> County of tAo(*W ) <br /> ' I, 4J;ky axM 1,... VQ' of 1�iG.�►In10(1d T 11�coo i 5 <br /> (Name of Affiant) Q 9 (City of Affiant) (State of Affiant <br /> being first duly sworn upon oath, states as follows: <br /> ' 1. That I am the QCeS,AjAr of <br /> officer or position bidder <br /> 2. That I have personal knowledge of the facts herein stated. <br /> ' 3. That, if selected under this proposal, K<iNm,u* coy � "C-X-w 'S will maintain a <br /> (bidder) <br /> business office in the State of Illinois which will be located in tAof*c County, Illinois. <br /> ' 4. That this business office will serve as the primary place of employment for any persons employed in the <br /> construction contemplated by this proposal. <br /> ' 5. That this Affidavit is given as a requirement of state law as provided in Section 30-22(8) of the Illinois <br /> Procurement Code. <br /> r 4� s <br /> (Signature) <br /> Vz <br /> (Print Name of Affiant) <br /> This instrument was acknowledged before me on a 4+'4 day of a 1 <br /> OFFIC:KINNEY <br /> ' KATHERI(SEAL) NOTARY PUBLICILLINOISMY COMMISSION2/1012023 <br /> ' (Signatije of Notary Pub' <br /> ' Printed 3/4/2021 BLR 12326(01/08/14) <br />