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Street address 839 Mackenzie Avenue <br /> (Street number and name) <br /> Canon City CO 81212 <br /> (City) (Stare) (ZIP/Postal Code) <br /> (Province—ifapplicable) (Country) <br /> Mailing address P.O. Box 165 <br /> (leave blank if same as street address) (Street number and nane or Post OJfmce Box informattau) <br /> Canon City CO 81215 <br /> (Ci9) (State) (ZIP/Postal Code) <br /> (Province—ifapplicable) (Country) <br /> ID Number <br /> (Colorado Secretary of State ID number) <br /> Entity name or true name <br /> Form of entity <br /> Jurisdiction <br /> Street address <br /> (Street number and none) <br /> (00 (State) (ZIP/Postal Code) <br /> (Province—ifapplicable) (Country) <br /> Mailing address <br /> (leave blank if same as street address) (Street number and name or Post Office Box ihfonmation) <br /> (City) (State) (ZIP/Postat Code) <br /> (Province—ifapplicable) (Country) { <br /> pfthe following statement applies,adopt the statement by marking the box and include an attachment.) <br /> ❑ There are more than three merging entities and the ID number(if applicable),entity name or true <br /> name,form of entity,jurisdiction under the law of which it is formed,and the principal address of <br /> each additional merging entity is stated in an attachment. <br /> 2. For the surviving entity,its entity ID number(if applicable),entity name or true name;,form of entity, <br /> jurisdiction under the law of which it is formed,and principal address are <br /> ID Number 19871465104 <br /> (Colorado Secretary of State ID number) <br /> Entity name or true name Fremont Paving and Redi-Mix, Inc. <br /> MERGE—DOM Page 2 of 4 Rev.5/29/2007 <br />