THIS FORM MUST BE SUBMITTED WITH ALL RESPONSES TO IFB
kh The following documents are attached to and made a condition of this BID:
A. Bid Form — which includes a tabulation of Subcontractors, Suppliers and other individuals and entities
required to be identified in this proposal;
B. Schedule of Values;
C. Bid Bond;
D. Construction Contractor’s Qualification Statement; and
E. Any and all addendums issued after the release of this BID. Upon issuance, addendums can be found
on the City website or on Bid Express with the original BID documents
8. Communications concerning this BID shall be addressed to:
Kelly Parkinson, Purchasing Manager
Email: purchasing@nashuanh.gov
Col . G
SUBMITTED on_t@-bf UCv 4 { 0 22.
Business Name (typed or printed): un Shri We | Avi ne, Cowpea dn uy?
L] Individual [1] Partnership [sd a [_] Joint Venture
Type:
[] General CI General
C1 Publicly Traded L] Professional
CL] Limited [LW services
WA L] Other C1 Limited Liability
# Robe t Bus Anal res, ‘don fF (SEAL)
Individual’ 's Signature, General Partner, Officer with authority to sign)
Doing Business as): le Ss) awe] “Ay LAY Coy pare AN
Business Address: cAC\y Com Sy ulna Dp fall ©
kad sean NW SSeS N
Phone: {(26) x5 & (j - -~S4uo0 Email: _| i
Date and State of Greanization: ie} \ ‘ec
Date and State of Incorporation: 2h Alin YVYYV\AS SacwWwA golts
Date of Qualification to do business is Ala Le
By:
Names of Current General Partners/Executive Officers/Joint Partners
Name: Title
Roeer kb VWDus hno \\ Presnlont
Danico ~Bushre \W\ VreaSuvre,-
(Indicate managing partner by an asterisk *)
IFBO660-020922 2022 PAVING PROGRAM Pagel3o0f5
