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I <br /> I Section 00 4113 <br /> Bid Form <br /> I13 DESIGNATED REPRESENTATIVES ��, c� <br /> Undersigned hereby designates ___\ [r c1 i <br /> I <br /> of its office to which notice of acceptance oft is Bid may be mailed or delivered. By <br /> submitting this bid,the undersigned bidder agrees that the City may use the following <br /> email address for all notices and correspondence with the undersigned bidder: <br /> 14, The full names and residences of all persons and parties interested in this Bid as principals are as <br /> Ifollows: <br /> NAME 77C �I` /TIT�LE�y q���� , ADDRESS <br /> I -;- -vi i <br /> I <br /> 15. By submitting this Bid, Bidder certifies that it has reviewed the insurance requirements of the <br /> General Conditions and certifies that coverage will be provided as required. <br /> ISigned this , day of NS\tat/�,P20/!� , 202.Z <br /> I DWI— <br /> Bidder Firm Name: C <br /> • <br /> Signature: <br /> Title: Ul&/14A/VIA1 E <br /> IAddress: e O 1976 X- S <br /> ICity/Zip: 4,4M,Ac . L 4 G U 22 <br /> Phone: J626 — tD(Dl — 1-5 , <br /> I 'tom. - • p -r-u 6-/L $l/Ib Q <br /> State of Incorporation Contractor's License No. <br /> IWashington State <br /> too - 63c— , - , <br /> IUBI Number <br /> 6OO 268 - , ,a - v <br /> IEmployment Security Account No. <br /> I <br /> END OF SECTION <br /> Rotary Park Renovation 3 of 3 <br /> IProvided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />