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SUBMITTED on Ll /2- z- 20 o `1. <br /> State Contractor License No. CGCv / z3 tt 6 <br /> If Bidder is : <br /> An Individual <br /> Name (typed or printed): <br /> By. (SEAL) <br /> (Individual's signature) <br /> Doing business as : <br /> Business address : <br /> Phone No. : FAX No . : <br /> A Partnership <br /> Partnership Name : (SEAL) <br /> 1 By . <br /> (Signature of general partner -- attach evidence of authority to sign) <br /> Name (typed or printed) : <br /> Business address : <br /> Phone No. : FAX No . : <br /> LL (. <br /> A CorAotation <br /> Corporation Name : a- w • L k m.-Rc„,.,,, , LL (SEA'") <br /> of Incorporation : L . <br /> Type (General Business, Professional , Servic Limited Liabilit _ <br /> f By: <br /> (Signature -- attach evidence of authority to sign) <br /> Name (typed or printed) : S 0) LL I <br /> Title: <br /> AttestTress: <br /> ---�1 (CORPOP.ATE SEAL) <br /> rporate Secretary) <br /> /lS t" P c <br /> Busin73 gT�tP, . f Fl . <br /> w P !3i jr:;: L.• 33 kI <br /> Phone No. : � ���rl � / — yl , , FAX No . : <br /> Date of Qualification to do business is <br /> 00310 - 12 <br /> 100310 - Bid Form.doc <br />