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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 /> I 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 /> &26/2014 3:38:29 PM <br />