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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 21-00108-00-FP <br /> Route Various Streets <br /> State of <br /> _k"LlI x.101 S ) <br /> ) SS. <br /> County of Ak_A-r r,1 ) <br /> I N V\1 . TU of D�l�t�- _ -�liC-l l0 0 t S <br /> (Name of Af a t) (City of Affiant) (State of Affiant <br /> being first duly sworn upon oath,states as follows: --D�f NW 69y'-&P i <br /> 1. That I am the PR,� I M�1 of b d1 S <br /> officer or position bidder <br /> 2. That I have personal knowledge of the facts h r M t ted. <br /> DO <br /> 3. That, if selected under this proposal, 'nt m aA( n✓ 7 , will maintain a <br /> (bidd�) <br /> business office in the State of Illinois which will be located in 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 /> (Signalu ) <br /> (Print Vame of Afflanl) <br /> This instrument was acknowledged before me on "day of <br /> U <br /> (SEAL) <br /> "OFFICIAL SEAL" <br /> TIFFANY C CRAW <br /> NOTARY PUBLIC,STATE OF ILLINOIS <br /> MY COMMISSION EXPIRES 06.24.2023 <br /> aul/ <br /> "(Signitu, <br /> otaryPublic) <br /> Printed 2/12/2021 BLR 12326(01/08/14) <br />