Laserfiche WebLink
p#r'1Sp{?I'' 1C�1 Affidavit of Illinois Business Office <br /> Local Public Agency County Street Name/Road Name Section Number <br /> City of Decatur Macon liVarious 23-00308-00-FP <br /> Name of Affiant City of Affiant State of Affiant <br /> being first duly sworn upon oath, state as follows: <br /> 1.That I am the NJ qk oI of <br /> �`[iJ <br /> ' Officer or Position Bidder <br /> 2.That I have personal knowledge of the facts herein stated. ,p n <br /> ��W �r FaG <br /> ' 3.That, if selected under the proposal described above, —C , ,will maintain a business office in the <br /> Bidde <br /> State of Illinois,which will be located in County, Illinois. <br /> ' County <br /> 4.That this business office will serve as the primary place of employment for any persons employed in the construction contemplated by <br /> 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 Procurement Code. <br /> Si nature&Date <br /> J <br /> 0 <br /> Print Name of Affiant <br /> 101 <br /> Notary Public <br /> ' State of IL <br /> County U" <br /> ' Signed (or subscribed or attested) before me on D .2?j by <br /> (date) <br /> i <br /> `'(��,t t& • e�?tiC. authorized agent(s) of <br /> bw(e� /� (name/s of person/s) <br /> '�1��/' WC i <br /> Bidder T <br /> "OFFICIAL SEAL" <br /> TIFFANY C CRAW a Public Signature&Date <br /> ' NOTASALRY PUBLIC,9TATI OF ILLINOIS <br /> MY COMMISSION EXPIRES 06.24.2027 <br /> 0� <br /> ' (SEAL) My com fission expOe ?,�?�"7 <br /> ' Completed 07/07/23 Page 1 of 1 BLR 12326(Rev. 01/20/23) <br />