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An Individual <br />Name (typed or printed): N/A <br />By. (SEAL) <br />(Individual's signature) <br />Doing business as: <br />Business address: <br />Phone No.: <br />Email: <br />,A Partnership <br />Partnership Name: <br />N/A <br />FAX No.: <br />By: <br />(Signature bf general partner -- attach evidence of authority to sign) <br />Name (typed or printed): <br />Business address: <br />Phone No.: FAX No.: <br />Email: <br />A Corporation <br />(SEAT,) <br />Corporation Name: Advanced Roofing, Inc, (SEAL..) <br />State of Incorporation: _ Florida <br />Type (General Business, Professional, Service, Limited Liability): Roofing, Professional Corporation <br />By. .�. _ I? -- <br />(Signature - attach evidence of authority to sign) <br />Name (typed or printed): Robert P. Kornahrens <br />11fle: President/ Owner Secretary <br />Attest <br />(Signature of Corporate <br />iei rornanrens, <br />Business address: 1950 NW 22nd Streets Fort Lauerdale, FL 33311 <br />Phone No.: 954) 522-6868 - FAX No.:. (954) 522-2967 <br />Email: MichaelK(@AdvancedRoofing.com <br />Date of Qualification to do business Is 110812017 <br />0 <br />(CORPORATE SEAL) <br />RO <br />GOgI'0 <br />►SEAAE� <br />.1983 n <br />A Joint Venture <br />00310 - Bid Form REV 04-07.doc <br />00310-5 <br />F:IPab9v Wo&%kENGINEBRING DIVISION PROJECTS11705 B:uldlnos A& 8 RcoY Ro*cemen[k1-AdminWjd DocumenlsWasleeCenhei D=m&*'a0310-Bid Farm REV <br />04VADc <br />