2021-03-24_PERMIT FILE - M2021019 ‎(2)‎

• Permit No: M2021019
• IBM Index Class Name: Permit File
• Doc Date: 3/24/2021
• Doc Name: Application
• From: Ames Construction
• To: DRMS
• Email Name: TC1
• Email Name: MAC
• Email Name: AWA
• Email Name: SMS
• Media Type: D
• Archive: No

DocuSign Envelope ID:7FFCOE71-7C9F-498C-9A8A-D9969FBC8D7D
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Fps-`Collins Official Purchasing Document
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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 construction
and building materials for the exempt project described xpla no employees the(CAN)box and provide
e
below This exemption does not include or apply to the explanation Far example.
ple, I have no employees or
purchase or rental of equipment, supplies, and materials subcontractors and perform all of the work myself,
which are purchaised, rented,or consumed by the Subcontractors:
contractor and which do not become a part of the structure, Subcontractors will not be issued CertAcates 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 d by filling in the subcontractor's name and address and
penalties provided by law signing it The original Certificate should always be retained
A separate certificate is required for each project. by the prime contractor. Copies of all Certificates that the
pa 4 pr 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
AColorado Account Number(CAN)should be provided in an audit.
this field Applications that are left blank or list N/A will not See FYI Sales 95 for information about qualifying affordable
be processed and will be returned housing projects
Subsidiary: To This box is marked when a subsidiary is using the parents avoid A returned application ensure you have done
t
withholding account number(only when it does not have its the following:
own )Provide the parents CAN, Accurately completed all applicable taxes of
Subcontractor: the form
This box is marked when a contractor does not have J Provided a copy of the Contract or agreement page
employees of their awn and outscurces their employees The Contract or Agreement page lists the#Ipe and
through a subcontractor. List the subcontractor or scope of work
subcontractors name and CAN(s) Bid amount on Contract or Agreement page
Staffing Agency: matches the amount listed on the application
This box is marked when a contractor does riot have (to the penny)
employees of their own and outsources their employees Contract or Agreement page contains the
through a staffing agency. Provide the Stafflog Agency's signatures of the contracting parties
name and CAN
� The form DR{7172(application)is signed
The exempt organizations number was provided
and is correct.
Services Agreement—Work Order Type
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