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<br />Palle4 Of 4 <br /> <br />EXCEPTIONS: <br /> <br />NOkl€. <br /> <br />Any exception listed above will not necessarily result in denial of award, but will be considered in determining bidder <br />responsibility. For any exception noted, indicate to whom it applies, initiating agency and dates of agency action. Providing false <br />information may result in criminal prosecution and/or administrative sanctions. I declare under penalty of perjury that the foregoing is <br />true and correct. <br /> <br /> <br />INDIVIDUAL OR FIRM TRADING AS: <br /> <br />. Bidder <br /> <br />Signature: <br /> <br />Signature: <br /> <br />Individual or Owner <br /> <br />.JJectDr W. Or+lZ- <br />. . Print Name <br /> <br />Print Name <br /> <br />.(Affix <br />Corporate <br />Seal) <br /> <br />JOINT VENTURE: <br /> <br />PARTNERSHIP <br /> <br />Bidder <br /> <br />Signature: <br /> <br />Bidder <br /> <br />Attorney-in-Fact <br /> <br />Signature: <br /> <br />General Partner (Circle Title) <br /> <br />Print Name <br /> <br />Print Name <br /> <br />CONTRACTOR: <br /> <br />(Seal) <br /> <br />Signature: <br /> <br />Signature: <br /> <br />President or Vice President (Circle Title) <br /> <br />General Partner (Circle Title) <br /> <br />CONTRACTOR: <br /> <br />(Seal) <br /> <br />Print Name <br /> <br />Signature: <br /> <br />President or Vice President (Circle Title) <br /> <br />LIMITED LIABILITY COMPANY: <br /> <br />CONTRACTOR: (Seal) <br /> <br />Contractor <br /> <br />Signature: <br /> <br />President or Vice President (Circle Title) <br /> <br />Signature: <br /> <br />Manager or Member (Circle Title) <br /> <br />Print Name <br /> <br />Organized and existing under the laws of the State of FLORIDA and authorized to do business in the State of Florida, pursuant to the laws of the State of <br />Florida, certificate of incorporation or organIzation or certificate 01 authonty haVing been issued by the Florida Department of State. <br /> <br />FAILURE TO FULLY COMPLETE AND EXECUTE THIS DOCUMENT MAY RESULT IN THE BID BEING DECLARED NONRESPONSIVE <br /> <br />ATTACH BID BOND <br />Job No(s). 409268-1-52-01 <br /> <br />RECYCLED PAPER * <br />