A Corporation
7 / “>
Corporation Name: Ou aNat ne | AV As Co f Q ova sti (SEAL)
Date and State of Incorporation: 3) 4 ly — Ma SISachu sed Ls
List of Executive Officers
Name Title
Roles “Bushnell f Pesidon t
Type (Gengtra ip€ss, Professional, Service, Limited Liability): Se Vii ee
By:
r (Signature -- attach evidence of authority to sign)
Name (typed or printed): Robo 4 “Push re of
Title: Besidon. L (Corporate Seal)
Attest:
(Signature of Corporate Secretary)
Business Address: 84 Yen delvrw le el
Noh Claims rol, MA O13
Phone No. (3% 2S6-123% —FaxNo: T?¥ 251-399]
Date of Qualification to do business is 3| Aly
A Joint Venture |
Bid Form
Joint Venture Name: iS) | A (SEAL)
Date and State of Organization: |
Name, Address and Form of Organization of Joint Venture Partners: (Indicate managing partner
by an asterisk *)
BF 5 of 8
