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i <br /> I <br /> SUBMITTED on 921 , 20111 <br /> State Contractor License No . <br /> CGC1519919 <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 N.o_: FAX No. : <br /> Limited Liability orr wny <br /> =A=Partn&rskrfp= <br /> LLC gnefshb :Nanje uca e Acquisitio om LLC (SEAL) <br /> By: <br /> (Signature of fir# -- attach evidence of authority to sign} <br /> Name (typed or printed): Wade E. Diekman , Vice-President <br /> I <br /> I <br /> Business address : 3130 SE Slater St. , Stuart , FL 34997 <br /> Phone No. : 772-286-5094 FAX No . : 772-403-2378 <br /> I " <br /> A Corporation <br /> Corporation Name : (SEAL) <br /> State of Incorporation : <br /> Type (General Business , Professional , Service , Limited Liability): <br /> By : <br /> I (Signature — attach evidence of authority to sign) <br /> Name (typed or printed ) : <br /> Title : <br /> (CORPORATE SEAL ) <br /> Attest <br /> (Signature of Corporate Secretary) <br /> Business address : <br /> 00390 - Bid Form REV 04-07 .doc <br /> 00310-8 <br /> F :\Public Works\ENGINEERING DIVISION PROJECTS\0208-02nd Ave Bridge Replacement at 4th StlAdmimWd documents\00310 <br /> - Bid Form REV 04-07.doc <br />