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SUBMITTED on FP�, ZZ 20-a. <br />State Contractor License No-cisC®5 Z9 b0 <br />If Bidder is: <br />An Individual <br />Name (typed or printed): <br />By: <br />(Individual's signature) <br />Doing business as: <br />Business address: <br />Phone No.: FAX No.' <br />Email: <br />A Partnership <br />Partnership Name: <br />By: <br />(Signature of general partner -- attach evidence of authority to sign) <br />Name (typed or printed): <br />Business address: ` <br />Phone No.: <br />Email: <br />FAX No.: <br />(SEAL) <br />(SEAL) <br />A Corporation <br />Corporation Name: SR (SEAL) <br />State of Incorporation: M V <br />Type (General Business, Professional, Service, Limited Liability): <br />(Signature — attach evidence of authority to sign) <br />Name (typed or printed): t YYr�� � SC_.. <br />Title:--�reQA 1 <br />(CORPORATE SEAL.) <br />Attest <br />( ignature of Corporate Secretary) <br />Business address: , &W oL O\sDuA Suij- It <br />Phone No.:-= -YCC�o FAX No.: <br />Email `t± eLA. R_A- N?_ En MC' 4N- --,rte"' <br />Date of Qualification to do business is <br />00310 -Bid Form REV 04-07 <br />00310 - 6 <br />R\Public Works\ENGINEERING DIVISION PROJECM1324 58th Ave Resurfadng (N. of 26th Sl to N. of 57th St)\1-Admin\Bid documentsWaster Contract Documents\00310 - <br />Bid Form REV 04-07.doc <br />