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RETURN WITH BID <br /> 0 Illinois Department <br /> of Transportation Affidavit of Illinois Business Office <br /> County Macon <br /> Local Public Agency City of Decatur <br /> Section Number 21-00133-00-PV <br /> Route FAU 7452 <br /> State of X w�I,. 10t S ) <br /> ) SS. <br /> County of VVV<-Ltj)Q ) <br /> 1, �'C111 I> W • "��/t20L.� of V �Crr t�--- (�t.t.t /�-�0t s <br /> (Name of Affia ) (City of Affiant) (State of Affiant <br /> being first duly sworn upon oath, states as follows: _Q01113 0Vk1A PA-IQFA / <br /> 1. That I am the 7(V465xp6Nq of CSI. JIStJIS pF ( p pII :V .- <br /> officer or position bidde <br /> 2. That I have personal knowledge of the facts herein stated. A <br /> 3. That, if selected under this proposal, pI JNLSIDJ�,,t by T 01f(� C,• will maintain a <br /> (bidder) <br /> business office in the State of Illinois which will be located in P"A-4- 5 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 /> —9 - At <br /> ' �• <br /> ( i nature) <br /> (Prin Name of ffiant) <br /> This instrument was acknowledged before me on l day ofL . <br /> ENOTARY <br /> FICIAL SEAL" <br /> FANY C CRAW <br /> (SEAL) UBLIC,STATE OFILLINOIS <br /> SION EXPIRES 08.24-2023 <br /> Signature f otary Public) <br /> r <br /> Printed 4/28/2021 BLR 12326(01/08/14) <br />