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Business address : Old b `X E hIA, ,JSCA3 #719t �'Iw Id Dixie Hwy Sui�e 106 <br /> r' -IAto Beach , FL 32962 <br /> Phone No . : `1715UW _1 S5 ` Tj FAX No . : 7 L/ <br /> Date of Qualification to do business is <br /> A Joint Venture <br /> Joint Venture Name : (SEAL ) <br /> By. <br /> (Signature of joint venture partner -- attach evidence of authority to sign) <br /> Name (typed or printed ): <br /> Title : <br /> Business address : <br /> Phone No . : FAX No . : <br /> Joint Venture Name : (SEAL ) <br /> By . <br /> (Signature -- attach evidence of authority to sign) <br /> Name (typed or printed ) : <br /> Title : <br /> Business address : <br /> Phone No . : FAX No . : <br /> Phone and FAX Number, and Address for receipt of official communications : <br /> ( Each joint venturor must sign . The manner of signing for each individual , partnership , and <br /> corporation that is a party to the joint venture should be in the manner indicated above . ) <br /> 00310 - Bid Form REV 04-07 .doc <br /> 00310 - 5 <br />