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INDIAN RIVER COUNTY, FLORIDA <br />SEALED BID NO. 2014032 <br />PROJECT NO. 0845B <br />FM NO. 423186-2-58-01 <br />OLD DIXIE HIGHWAY SIDEWALK IMPROVEMENTS <br />38TH LANE TO 45TH STREET <br />CONTRACTOR VERIFICATION FORM <br />THE FOLLOWING IS TO BE COMPLETED BY PRIME BIDDER: <br />Name of Firm. <br />Corporate Title. <br />Address: <br />(Zip Code) <br />By: <br />(Print name) (Print title) <br />(Authorized Signature) <br />Telephone: ( ) <br />Fax: ( ) <br />State License # (ATTACH COPY) <br />County License # (ATTACH COPY) <br />City License. (ATTACH PROOF OF REGISTRATION WITH THE CITY) <br />Type of License: <br />Unlimited (yes/no) <br />If "NO", Limited to what trade? <br />P-59 Contractor Verification <br />8262014 3:38:29 PM <br />