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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 />Email: <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 />Email: <br />A Corporation <br />Corporation Name: Timothy Rose Contracting <br />State of Incorporation: Florida <br />Type (GeneralAtisiness, Professional, Service, Limited Liability): Corporation <br />By: <br />(SEAL) <br />,(Signature -- attach evidence of authority to sign) <br />Name (typed or printed): Timothy Rose <br />Title: President <br />Attest <br />(CORPORATE SEAL) <br />�)NQ <br />Onatuie of Corporate Secretary) <br />Business address: 136o SW Old Dixie Hwy Suite 106 Vero Beach FL 32962 <br />Phone No.: 772.564.7800 <br />Email: Tim Rose7@comcast.net <br />FAX No.: 772.564.7888 <br />Date of Qualification to do business is <br />8/1991 <br />00310 - Bid Form REV 04-07 <br />00310 - 7 <br />F:1Public Works IENGINEERING DIVISION PROJECTS \1362 -Old Dixie Hwy_Highland DM -Admit -I\ Bid Documenls\Master Contract Documenls\00310 - 8id Form REV 04-07.doc <br />