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State Contractor License No . G C o G <br /> If Bidder is : <br /> A Corp9r9tion --� <br /> Corporation Name : r � ' w ' �- � �� r'` ' ' L �' (SEAL) <br /> State of Incorporation : _ t- • <br /> Type ( General Business , Professional , Servic Limited Liability) : <br /> (Signature — attach evidence of authority to sign) <br /> Name (typed or printed ) : Jae 7'G h'� • h-� o kss -' <br /> Title: V I _C -C= •.mss . � � .- <br /> ( CORPORATE SEAL) <br /> Attest <br /> (Signgturf gftorporate Secretary) ' <br /> Business address : 73 el r; wcstP ' ' -+ P I <br /> Wo F6 B � 3 3 1113 <br /> Phone No . : ( * A I I h 7 i - 4 ! a a FAX No . : ( 561 ) 1171 — e348' <br /> Date of Qualification to do business is Z ti <br /> * * END OF SECTION <br /> 00310 - Bid Form REV 04-07 <br /> 00310 - 10 <br /> y F:\Engineering\Capital Projects\0803 17th Lane SW Roadway Improvements from 27th Ave to approx. 900 LF east of 27th Ave\0803 Contract Documents\0031 <br />D - Bid Form <br /> REV 04-07.doc <br />