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License No. <br />Attest: (Where applicable) <br />Deputy Clerk <br />(SEAL) <br />Designated Representative: <br />Name: _ <br />Title: <br />Address: <br />Phone <br />Email <br />Page 20 of 22 <br />Agent for service of process. �� -�p� e� M�N1►�1+� <br />Designated Representative: <br />Name: J'-'z'A. (3, M'Nkvr <br />Title: V Scar—� <br />Address: <br />p L1 L <br />1��� �% MV, NJ'yV SfV CGI <br />Phone: %4 - 2I8- Z3Z2 i <br />Email:. �acJ�.....�,—+`I+�. �%C.�i�S w'1o� lc S + ++c <br />(if Contractor is a corporation or a partnership, <br />attach evidence of authority to sign.) <br />