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' ���►) Illinois Department <br /> n <br /> !rI of Trasportafion Affidavit of Illinois Business Office <br /> Local Public Agency County Street Name/Road Name Section Number <br /> ' City of Decatur Macon East William Street 22-00237-00-IC <br /> of <br /> ' Name of Affian ity of Affiant State of Affiant <br /> being first duly sworn oath, ate as follows: / <br /> 1. That I am the V. L t�''`�� of f(.`^n � — <br /> ' Officer or Position Bidder <br /> 2. That I have personal knowledge of the facts herein stated. J e <br /> ' 3. That, if selected under the proposal described above, (`^nom ��InqG will maintain a business office in the <br /> Bidder <br /> State of Illinois,which will be located in U 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 /> SianatLAe&Date <br /> 3 <br /> ' Print Name of Aff <br /> Notary Public <br /> State of IL <br /> County M494� m <br /> Signed (or subscribA or attes d)before me on 1 I 1 o by <br /> ' (date) <br /> LO/ G 4o 4 authorized agent(s) of <br /> l� 1 1 (name/s of person/s) <br /> (C•' �� Y rcG r'Se;F nC <br /> Bidder <br /> Notary Public Signature& Date <br /> ' OFFICIAL SEAL <br /> OALENE SLIGHTOM <br /> NOTARY PUBLIC,STATE OF ILLINOIS <br /> MY COMMISSION EXPIRES 05/14/2024 My commission expires ?�14�2p2 y <br />' Completed 09/13/23 Page 1 of 1 BLR 12326(Rev. 01/20/23) <br />