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contractor /~ ~ w~.~.. P.-ws ~rc~ ~~... <br />Address ~o t 4 1Qa."~^~cjc Qoc-.d ~i (1a~ _ A/ . C . a ?S e 3 <br />T <br />Phone Number 9 t ~ `t"T ~l '~ Z6~o Fax Number 4 ! ~'t ~-f ? 4 ®~ E .3 <br />Federal Identification Number J~(rs t a ? t 4 Z. Fj <br />Contractors L~nse Number 36 g $ 'L. <br />Authorized <br />Signature <br />r-tle Pa Es , <br />Title ~ ~ ~ ~ t (e - D `J' <br />.. .. - <br />Subscribed and sworn to me this the <br />~~ Day of l~rtr,~6r.~ 20 U ~ <br />`~~~ ~ 1 - N t I 1 r ! - ! ! ~ j~~i <br />~~~~ ~,Nf1OO ~~fii <br />:' ~I~~~~:,yd <br />.~~ <br />Q_ <br />:.~ <br />~~~ db10N= <br />'. ~'b "'• •......••~ a ~~. <br />~~~~`',~lb3 IIC~~ ``\`~~ <br />Of ~~u-~'ftlL+h7 County. <br />state of ~ C-- <br />(Signs ure of Notary Public) <br />My Commission Expires c~~le~,~i3 <br />THIS SECTION TO BE COMPLETED BY NORTH CAROLINA DEPARTMENT OF TRANSPORTATION <br />This bid has tieen reviewed in acxordance with Article 103-1 of the Stanrtarct Specifications for Roads and <br />Structures dated July 1, 2006. <br />Reviewed by <br />Dake <br />67 <br />Affix Comorate Seal or Notarize Contract Bid Form <br />CORPORATE SEALlNOTARY SEAL <br />