2021-03-16_REVISION - M2021013 ‎(2)‎

• Permit No: M2021013
• IBM Index Class Name: Revision
• Doc Date: 3/16/2021
• Doc Name: Adequacy Review Response
• From: Ames Construction
• To: DRMS
• Email Name: TC1
• Media Type: D
• Archive: No

DocuSign Envelope ID:7FFCOE71-7C9F-498C-9A8A-D9969FBC8D7D
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Special Notice
Purpose of this application No employeeslno subcontractors:
For contractors with no employees, no subcontractors)
The exemption certificate for which you are applying must staffing agencies:
be used only for the purpose of purchasing oonstrucbon
h
and building materials for the exempt project described Write no employees the(CAN)box and provide
below This exemption does not include or apply to the explanation For example,
ple, I have employees or
purchase or rental of equipmert, supplies; and materials subcontractors and perform all of the work myself.
which are purchased, rented, or consumed by the Subcontractors:
contractor and which do not become a part of the structure, Subcontractors will not be issued Certificates of Exemption
highway,road. street or other public works owned and by the Department of Revenue. Upon receipt of the
used by the exempt organization. Certificate, the prime contractor should make a copy for
Any unauthorized use of the exemption certificate will each subcontractor involved in the project and complete
result in revocation of your exemption certificate and other it by filling in the subcontractor's name and address and
penalties provided by law signing it The original Certificate should always be retained
by the prime contractor. Copies of all Certificates that the
A separate certificate is required for each project. prime;contractor issued to subcontractors should be kept at
the prime contractor's place of business for a minimum of
Colorado Withholding Account Number three years and be available for inspection in the event of
A Colorado Account Number(CAN)should be provided in an audit.
this field Applications that are left blank or list NIA will not See FYI Sales 95 for information about qualifying affordable
be processed and will be returned housing projects
Subsidiary
This box is marked when a subsidiary is us th
using the parents avoid a returned application ensure you have done
withholding account number(only when it does not have its the fallowing:
awn)Provide the parents CAN, —) Accurately completed all applicable boxes of
Subcontractor: the fo rrn_
This box is marked when a contractor does not have Provided a copy of the Contract or agreement page
employees of their own and autscurces their employees The Contract or Agreement page lists the type and
through a subcontractor List the subcontractor or scope of work
subcontractors name and CAN(s) Bid amount on Contract or Agteement page
Staffing Agency: matches the amount listed on the application
This box is marked when a contractor does not have (to the penny)
employees of their own and outsources their employees ❑ Contract or Agreement page contains the
through a staffing agency. Provide the Staffing Agency's signatures of the contracting parties
name and CAN
1 The form DR0172(application)is signed
The exempt organizations number was provided
and is correct.
Services Agreement—Work Order Type
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