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SUBMITTED on - , 20\O . <br />State Contractor License No. ikv..NN 0 (4, (., S \ <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: C\;A,ioru te,oKe.c pctu1.01/40? s* \-L C--- (SEAL) <br />State of Incorporation: V1or; <br />Type (General Business, Professional, Service, Limited Liability): l� r�;,�ccl L, <br />By: /la- )&6I <br />(Signature — attach evidence of authority to sign) C-.' a\zoo \W -, >cce\a c <br />Name (typed or printed): C\; 010 c\ . -Vzzc.;1,c <br />Title: C> W r..) -e Q . <br />Attest MA - <br />(CORPORATE SEAL) <br />(Signature of Corporate Secretary) <br />Business address: \IN°\ "SS. z; a\sbk4 <br />Phone No.:ha .S•)n-'los k FAX No.: -7").1 • 4 I21C,00l 9 <br />Date of Qualification to do business is 00 <br />00310 - Bid Form REV 04-07.doc <br />00310 - 6 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\0946-47TH Street (US1 to Terminus Point)WdrMm\bid documents \0946 Contract Documents\00310 - Bid Form REV 04- <br />07.doc <br />