THIS FORM MUST BE SUBMITTED WITH ALL RESPONSES TO THIS IFB
229 Main Street, City Hall
Nashua, NH_03061-2019
SUBMITTED on ,20 21
Business Name (typed or printed):
Dindividual - DPartnership DCorporation DJoint Venture
——_—"
Type: (Oceneral) DGeneral Business
DPublicly Traded DProfessional
DLimited DServices
DOther DLimited Liability
By: Parke. GC) AQoa (SEAL)
(individual's Signature, Gen Partner, Officer with authority to sign)
Doing business as: “a ud ley S MNCeSSIMS
\
Business address: 34 Came Saagent 2D
_Yientimorte NH 03054
Phone:_bpo4-9G66 "T74S" _Email.: dud le VV
Date and G/ / [ il State of Aléiw HavdiptenaOrganization__
Date and State
of Incorporation:
Date of Qualification to do business is & /// Ligu
Names of Current General Partners/Executive Officers/Joint_ Partners
Name: Title
OW
(Indicate managing partner by an asterisk *)
Address for receipt of official communications:
“3b Camp Sasa ent: LD
Wiener maw AE O30SY
Each joint ventured must sign. The manner of signing for each individual, partnership and corporation that is a
party to the joint venture should be in the manner indicated above
BF -4o0f7
