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Old -Dixie Hwy Suite 106 ' <br /> SUBMITTED on S?j0 r � , 20� VSO =Beach TL 329.69 ` <br /> State Contractor License No . ccv C 0' S of L J d <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 � ___ - J <br /> : � � -'� Cr) +10 VAC <br /> Corporation Name - t -u-S� ' i (SEAL ) <br /> State of Incorporation : <br /> Type ( General Busiawn , Professional , Service , Limited Liability) : aj> <br /> SRV - <br /> (Sig <br /> ( <br /> (Si -- attach evidence of authority to sign) <br /> Name (typed or printed ) : <br /> Title : ` -�r^ L'�4 ,•Tt <br /> . �� (CORPORATE. SEAL ) <br /> Attest Ceti` <br /> (Signature of Corporate Secretary) <br /> L <br /> 00310 - Bid Form REV 04-07 . doc <br /> nnA1n A <br />