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1�1 <br />M** <br />CONTRACTOR TO COMPLETE: <br />Business license: <br />Date of Issue: <br />Request for Bid #4367 <br />Page No. 6 <br />Contractor' s license: —jee (TC TO <br />Number and Class: 3 S�4g <br />Date of Issue: <br />Name of Insurance <br />Carrier: <br />Workman's <br />Compensation: <br />Public Liability <br />P&P616ZJ'C rA1d<-.1nN; <br />4/ Expires: <br />Expires: <br />-/'- /-FS- <br />I;?- <br />-FS-e <br />I;?- J- F?. <br />NOTE: Proof of maintenance of adequate insurance shall be required before <br />award will be made to vendor. If not already on file with the Purchasing <br />Department, be sure it accompanies your bid response. <br />