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� <br /> I � RETURN WITH BID <br /> II�tOIS Department <br /> I o�f <br /> Tra on <br /> Affidavit of illinois Business O�ce <br /> County Macon <br /> Local Public Agency Citv of Decatur <br /> Section Number 15-00527-00-GR <br /> ' Route Lost Bridae Road <br /> State of `L C/nI0/s ) <br /> ) ss. <br /> � County of �401�. ) <br /> �, �VL-�E�'T � ��L� of �-/C/-�-G-o, , ��L/1�0(S <br /> � (Name of Affiant) (City of A�ant) (State of Affiant <br /> being first duly sworn upon oath, states as follows: �^ <br /> ' 1. That I am the �C l�fi/-}'+1�.� of �-t r r� w�s� TC/✓C� w�-PO�A-r/�I� <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, /�/( /�W�ST ��� �/Z/l��41�1Q� , will maintain a <br /> (bidder) <br /> business office in the State of Illinois which will be located in ��J� 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 A�davit is given as a requirement of state law as provided in Section 30-22(8) of the Illinois <br /> Procurement Code. <br /> ����� ; 1 <br /> C�._ t:,��- � "�� i <br /> C.�,�i?<-t:�- <br /> L (Sign t re) <br /> .�1/El2 FTT `l. ��L L <br /> (Print Name of Affiant) <br /> � � r� <br /> This instrument was acknowledged before me on ��� day of /Lj�ay��/� , ��'�� . <br /> � <br /> � �0��.�S�', <br /> ELI7ABETH WA�'ON <br /> (SEAL) NolaryPublk.5������16 <br /> AM�omm�� <br /> � ..� tid....�... <br /> �� l.�-(.�G�. �:t. <br /> � (Signature of tary Public) <br /> � <br /> �� <br /> � Printed 8/27/2015 BLR 12326(01/08/14) <br /> � <br />