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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: W&J Construction Corp. (SEAL) - <br />State of Incorporation: Florida <br />Type (General Business, Professional, Service, Limited Liability): General Business <br />By: t <br />(Signature -- attach evidence of authority to sign) <br />Name (typed or printed): Erik Cosin <br />Title: ice President <br />(CORPORATE SEAL) <br />Atte Sheryl Derosia <br />e of Corporate Secretary) <br />Business address: 1038 Harvin Way, Suite 120 <br />Rockledge, FL 32955 <br />Phone No.: <br />Email: <br />321.632.7660 FAX No.: 321.632.5927 <br />erik@wjconstruction.com <br />Date of Qualification to do business is March 17, 1965 <br />00310 - Bid Form REV 04-07 <br />00310 - 5 <br />F:\Public WorksIENGINEERING DIVISION PROJECTS11728 IRC Courthouse Renovations Project\1-Admin\Bid Documents\Master Contract Documentsl00310 - Bid Form REV <br />04-07.doc <br />