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� � <br /> RETURN WITH BID <br /> � <br /> Illinois Dep�tment <br /> � af Trar�sportation Affidavit of Illinois Business Office <br /> ' County Macon <br /> Local Public Agency City of Decatur <br /> Section Number 15-00524-00-SC <br /> ' Route Various <br /> 1 <br /> State of ,� ) <br /> , " ) ss. <br /> County of �_� ) <br /> �, �u��5 .,S . �(l��1 of J� _ Ca,�� , ;�-(r�S�.rLI , <br /> ;-( <br /> I ' (Name of AffianQ (City of Affiant) (State of Affiant <br /> being first duly sworn upon oath, states as follows: <br />�' � 1. That I am the �r1,e,uc,�L i'�1,�..�� of �w(I�.�,,;5.�;�,�,�„� �uu1}�c;b�S LLG . <br /> o�cer or position bidder <br /> 2. That I have personal knowledge of the facts herein stated. <br /> ' 3. That, if selected under this proposal, /l'1(c�Q,c5��2i/k,�✓u �,���;Z?2S Lu� , will maintain a <br /> (bidder) <br /> business office in the State of Illinois which will be located in ��,u:u.� County, Illinois. <br /> ' 4. That this business office will serve as the rima lace of em lo ment for an ersons em lo ed in the <br /> P rYP p Y YP P Y <br /> construction contemplated by this proposal. <br /> 1 5. That this Affidavit is given as a requirement of state law as provided in Section 30-22(8) of the Illinois <br /> Procurement Cade. ^ <br /> / � <br /> ' 4 ' � <br /> � ��Signature) <br /> � ��s ���� <br /> ' (Print Name of Affiant) <br /> This instrument was acknowledged before me on '�� da of <br /> Y , ,�D�C� . <br /> ' <br /> ' MAR�AN WALTER <br /> ' � OFFICIAL SEAL <br /> �� �, � Notary PubliC.S�ate of Illinois <br /> \ �' �,,� My Commission Expnes <br /> (SEAL) � �- ap���oi, zois <br /> � <br /> � Si nature of Nota Public <br /> ( 9 ) <br /> ' Printed 4J8/2016 <br /> BlR 12326(01/08/14) <br /> � <br />