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Attachment C <br />Proposal for Towing Services <br />Pm-m1ge Ai r6 Trn-arepa,ti. <br />1. Business Name: J9V0n5+rtC6VArq 204.Email addressneG df 7 _f •�.01Y1 <br />2. Busines Address: �� l �+rlc _ <br />Phan 345 °l'-�"j-�l� <br />City: N r Zip: 33l LQ I <br />Mailing Address: IL4q I NE; lad afire _ <br />city., Nor+h M idmi i _ Zip:.33 l [,! <br />State type of business enterprise (e.g. corporation, association, partnership, organization, joint venture, <br />trust, foundation, firm, group, society, individual natural person, etc.): <br />3. NAME ALL OWNERS, OFFICERS, AND PERSONS HAVING AN INTEREST IN THE TOWING AGENCY: <br />(Attach additional sheets if necessary) <br />a. NAMEN _ cue l l �_ V � I Q.a_ SS# _1. tD 3 __P_LO L4 <br />ADDRESS�23 I C�� epee PHONE ��'- `���� <br />CITY 4aJ J -0[ _STATE F1, _BIRTHDATE _ –0-70 <br />b. NAME SS# <br />ADDRESS PHONE ­ <br />CITY STATE BIRTHDATE <br />c. NAME SS# <br />ADDRESS <br />CITY _ STATE <br />d. NAME_ SS# <br />ADDRESS <br />CITY STATE <br />PHONE . <br />_BIRTHDATE <br />PHONE <br />_BIRTHDATE <br />e. NAME <br />ADDRESS _— _ — _ PHONE <br />CITY _ _ _ STATE BIRTHDATE <br />4. Has the business enterprise, or any person whose name appears in this application, ever been convicted of any <br />crime? <br />If so, list the name, the arrest and conviction record of each person: <br />(Attach Additional sheets if necessary) <br />5. If a corporation, supply the following: <br />J7j=. fV R � til A rl' A CUMF,NT "C" <br />_Pr��gQ6 4-a 1rnr,,sPor4 +0114)9 -4- MCOVen., In,& . <br />