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SUBMITTED on 0 G + 1 - 3 , 2004 . <br /> State Contractor License No . C G c 0 5 ?,� S 4 5 <br /> If Bidder is : <br /> An Individual <br /> Name (typed or printed ) : <br /> By : (SEAL) <br /> (Individual 's signature) <br /> Doing business as : <br /> Business address : <br /> Phone No . : FAX No. : <br /> A Partnership <br /> Partnership Name : (SEAL) <br /> By: <br /> (Signature of general partner — attach evidence of authority to sign) <br /> Name (typed or printed ) : <br /> • Business address : <br /> Phone No. : FAX No . : <br /> A Corporation <br /> Corporation Name : Sy . , t-t- y- 'r ,A 7rt. . ( SEAL) <br /> State of Incorporation : P r'% *o. o, <br /> Type ( General Business , Professional , Service , Limited Liability) : 6 ec. e •� t L3 � S � •� S S <br /> By: -C�-�— <br /> (Signature — attach evidence of authority to sign) <br /> Name (typed or printed ) : w <br /> Title : p S <br /> (CORPORATE SEAL) <br /> Attest CkJ.,;__,_. <br /> (Signature of Corporate Secretary) <br /> Business address : '32, 00 43 r k ldv v e <br /> verg (S FL 3 z9 16 o <br /> Phone No. : -1 q 4 — 2 o r{ q FAX No . : " 7 q 4 2. 09 �1 <br /> Date of Qualification to do business is . - . 1999 <br /> IRC OPERATIONS COMPLEX 00310 — Bid Form <br /> 00310 - 8 <br />