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SUBMITTED on MARCH 2 20 21 <br />State Contractor License No.. QGC060797 <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 />rnone 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: DICKERSON FLORIDA, INC. (SEAL) <br />State of Incorporation: FLORIDA <br />Type (.Ge'n#ral Bu ' ess, rofessional, Service, Limited Liability): GENERAL BUSINESS <br />By: �r�13�—�_ �I <br />evidence of authority to sign) <br />Name (typed of printed): <br />Title: PRESI ENT <br />Attest <br />(SYgna are of Corporate Secretary) <br />'Business address: 3122 N. 25TH ST. <br />FT. PIERCE, FL 34946 <br />Phone No.: (772) 429-4444 FAX No.: (772) 429-4445 <br />Email: Idale _dfifl.com <br />Date of Qualification to do business is MARCH 1982 <br />(CORPORATE SEAL) <br />00310-5 00310 - Bid Form <br />FiPublic Work61ENGINEERING DIVISION PROJECTS11927 Round Island Beach ACCesSt1-Admin\BiilslBid DocumenlsiMasler Contract Docurn6ntst00310� Bid . rm:doc <br />