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Get Contract Registration Form 2013-2024

/State/Zip Cell phone # Office # Fax # Company Email Address QUALIFIER NAME: License # _ __________ Qualifier Email Address COPIES OF THE FOLLOWING DOCUMENTATION ARE REQUIRED: 1. 2. 3. 4. 5. Provided Qualifier’s Drivers License City Occupational License/Business Tax Receipt State Certification License # OR State Registration & Broward County Certificate of Competency Workers Compensation/Exemption General Liability Insurance* *Certificates of Insurance must show the City of Hallandal.

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