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Under penalty of perjury, Permittee declares that it has read the foregoing affidavit and the <br /> facts stated in it are true. <br /> FURTHER AFFIANT SAYETH NAUGHT <br /> Permittee: <br /> Authorized Signature: <br /> (If signing as Owner's Agent, attach Letter of Authorization to Sign from Owner) <br /> Printed Name: <br /> Date: <br /> Work Telephone: <br /> Mobile Telephone: <br /> Email Address: <br /> ********************************* <br /> The foregoing instrument was subscribed and sworn to before me this day of <br /> , 20_by <br /> who is personally known to me or has produced as <br /> identification and who did take oath. <br /> Notary Public State of Florida at Large <br /> My Commission expires: <br /> +++END OF SECTION+++ <br /> Last revised:6/29/2018 3 <br /> E\public works\engineering division projects\1760 victor hart sr.complex drainage improvements\1-admin\bids\bid documents\irc • <br /> - <br /> 1760_appen_c_20180813.doc <br />