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<br />Name & address of company submitting bid: <br /> <br />Federal Employer Identification # or Social Security #: <br /> <br />Telephone number ( <br /> <br />Fax number ( <br /> <br />Broward County Occupational License No. <br /> <br />expIres: <br /> <br />Manual signature of company officer: <br /> <br />Print Name: <br /> <br />Title of signer: <br /> <br />You must submit a completed W-9 form and a completed Bidder/Vendor <br />Disclosure form with your bid. <br /> <br />16 <br />