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If Bidder is. <br /> An Individual <br /> Name (typed or printed) . <br /> ■ <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 /> 1 A Corporation <br /> Corporation Name: Dickerson Florida , Inc . (SEAL) <br /> State of Incorporation: Pi gyri ria <br /> ' . Type (General Busines fessi <br /> , onal , Service, Limited Liability) : general business <br /> By <br /> (Signature Iatta evidence 7 authority to sign) <br /> Name (typed or printed): Larry T . Dale <br /> Title: President <br /> (CORPORATE SEAL) <br /> ' Attest <br /> (Signature o Corporate Secretary) <br /> Business address: 3122 North 25th Street <br /> Ft . Pierce , FL 34946 <br /> PhoneNo. : ( 772 ) 429 - 4444 FAXNo. . ( 772 ) 429 - 4445 <br /> Date of Qualification to do business is March 1982 <br /> 00310 34 <br /> 00310 - Bid Form REV 04-07.doc- <br /> VTudic WakMENGINEERWG DMSION PROJECTS%05454M Ave SRW to 57M St (Arc"sAA&*4"id D*o~sWW10 • Bid Form REV 04-07.doe <br />