Form Pn 869 - Bid Page 3

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RD Instruction 1924-A
Guide 1, Attachment 3
__________________________________________________________________________
NO._______ITEM________UNIT_______UNIT PRICE_______AMOUNT_______TOTAL PRICE
TOTAL OF BID . . . . . . . . . . . . . . . . . . . . . $ ____________________
LUMP SUM PRICE (if applicable) . . . . . . . . . . . . $ ____________________
Respectfully submitted:
_____________________________
___________________________________________
Signature
Address
_____________________________
_____________________
Title
Date
_____________________________
License number (if applicable)
SEAL - (if BID is by a corporation)
oOo
3/3
(2-16-83)
PN 869

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