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SUBMITTED on 10.30 20_ <br />State Contractor License No. CGC052940 <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 <br />rinted):Business address: <br />Phone No.: <br />Email: <br />G. ► • <br />A Corporation <br />Corporation Name: Timothy Rose Contracting Inc <br />State of Incorporation: Florida <br />Type (Gnal, Service, Limited Liability): <br />By: <br />(Signature -- attach evidence of authority to sign) <br />Name.(typed or printed): Timothy Rose <br />Title: President <br />Attest ^P^'rW—°`6iC- <br />a <br />(Signature of Corporate Secretary) <br />Business address: 1360 old Dixie Hwy SW <br />Vero Beach FL 32962 <br />Phone No.: 772-564-7800 <br />Email: timrose7(a).comcast.net <br />FAX No,: 772-564-7888 <br />Date of Qualification to do business is current <br />(SEAL) <br />(SEAL) <br />(SEAL) <br />(CORPORATE SEAL) <br />00310 - Bid Form REV 04-07 <br />00310- 19 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\0853-43rd AVE 181h ST to 26th ST (Arcadis)\1-Admin\Bid Documents\Master Contract Documents\00310 -Bid Form <br />REV 04-07.doc <br />