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RETURN WITH BID <br /> J <br /> 111nob Department <br /> of "rid On Affidavit of Illinois Business Office <br /> County Macon <br /> Local Public Agency City of Decatur <br /> ' Section Number 17-00708-00-FP <br /> Route Various <br /> 1 State of �('�� v t s ) <br /> ) SS. <br /> County of <br /> I, AAS W f- 4 ",-� of P�bpelix-4L L ,solS , <br /> (Name of Affiant) (City of Affiant) (State-of Affiant <br /> being first duly sworn upon <br /> /oath, states as follows: <br /> 1. That I am the j of WQ-�1[;�i,!kJL, <br /> officer or position I T bidder <br /> ' 2. That I haveers n <br /> p o al knowledge of the facts herein stated. <br /> 3. That, if selected under this proposal/ � �,.°6y�(,W will maintain a <br /> —t�'� (bidder) <br /> business office in the State of Illinois which will be located in County, Illinois. <br /> 1 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 /> (Signature) <br /> l� (Print Name of Affiant) <br /> This instrument was acknowledged before me on I <br /> g day of -7 . <br /> (SEAL) "OFFICIAL SEAL" <br /> ' TIFFANY 0 CRAW <br /> NOTARY PUSLIC,STATE*OF ILLINOIS <br /> MY COMMISSION EXPIRES 06.24.2018 \ <br /> 1 <br /> ( i nature optaPublic) <br /> Printed 3/14/2017 BLR 12326(01/08/14) <br />