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EXHIBIT A BID NUMBER : RFP/DF-04/05-99 OPENING DATE : JUNE 30 , 2005 @ 2 : 00 P. M. ATTACHMENT D 2005 EMERGENCY HURRICANE SUPPLEMENTAL URBAN AND COMMUNITY FORESTRY GRANT PROPOSAL FORM GENERAL INSTRUCTIONS : Please complete all items pertaining to the Category Grant for which you are applying . The proposal packet must not exceed thirty (30) one sided pages , including attachments . All attachments must be 8 1 /2" X 11 " , except any attached sketches , plans and maps which must be no larger than ZX T and folded into 8 1 /2 " X 11 " . Six ( 6) copies ( one copy with original signatures and ( 5) five copies ) of the proposal packet including the proposal form , the project description and all attachments must be received no later than 2 : 00 p . m . , June 30 , 2005 at : Department of Agriculture and Consumer Services Purchasing Office - U &CF - 2005 HURRICANE SUPPLEMENTAL PROPOSAL Mayo Building - Room SB-8 Tallahassee , FL 32399-0800 Telephone (850) 488-7552 If you have any questions , please see ATTACHMENT J , "Division of Forestry District/Center Contacts" PROPOSER INFORMATION ( Please Print or Type) Project Title : 012CA WV"M t4oK C00d7f? yAT1yW ftEPr 1" Proposer Name : INDtAi' 'RwW Cvv "Ty Name and Title of Contact Person : 'Ry1AVb M . be.;LD15 CNuff a F 6"WlRVNE ?t,ANN ) "A Address : V94D ZStk ST 'r VErdD BONC14 EL 3VJ &0D 331a`'.�- ' Zip : 329 &0 - 3;Np� Phone : ( 177 ) =4>� 1258 Is your organization a Nonprofit corporation pursuant to Chapter 617 , Florida Statutes? Yes No Ir/ FEID Number . sq ,o, &cPoo6r14 As the duly authorized representative of the Proposer named above , I hereby certify that all parts of the proposal and required grant information have been read and understood and that all information submitted herein is true and correct . Authorized Executive Officer: UID% if A , " IVP Title : CDv► ADNI� Nt �TRA'faF� Signature : 1 • Date : 31