2021-05-06_PERMIT FILE - M2021031 ‎(12)‎

• Permit No: M2021031
• IBM Index Class Name: PERMIT FILE
• Doc Date: 5/6/2021
• Doc Name: Application
• From: Ames Construction, Inc.
• To: DRMS
• Email Name: PSH
• Email Name: JLE
• Email Name: AWA
• Email Name: SMS
• Media Type: D
• Archive: No

DocuSign Envelope ID:7FFCOE71-7C9F-498C-9A8A-D9969FBC8D7D
City of
Fort Collins
Official Purchasing Document - -
Last updated 1012017
I„�������■! Q0 vw CO B02a -MWOtDEP T OF REVENUE
Oen
DO NOT SEND (309r MSERV(73M
Special Notice
Purpose of this application No employees/no 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 White no employees in the(CAN)box and provide
below This exemption does not include or apply to the explanation For example, I have no employees or
purchase or rental of equipment, 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 4 by filling in the subcontractors 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 eirent of
A Colorado Account Number(CAN)should be provided in an audrt.
this field Applications that are left blank or list N/A will not gee FYI Sales 95 for information about qualifying affordable
be processed and will be returned housing projects
Subsidiary: To avoid a returned application ensure you have done
Ths box is marked when a subsidiary is using the parents
withholding account number(only when it does not halve its the following:
own)Provide the parents CAN Accurately completed all applicable boxes of
Subcontractor: the form
Thiis box is marked when a contractor does not have Provided a copy of the Contract or agreement page
employees of their own and outsources their employees The Contract or Agreement page lists the type and
through a subcontractor Last the subcontractor or scope of work
subcontractors name and CAN(s) Bid amount on Contract or Agreement page
Starring Agency: matches the amount listed on the application
This box is marked when a contractor does rwt have (W the penny)
employees of their own and outsources their employees L-7 0orttract or Agreement page contains the
through a staffing agency Provide the Staffing Agency's Signatures of the contracting parties
name and CAN
❑ The form DR0172(application)is signed
❑ The exempt organizations number was provided
and is correct
Services Agreement-Work Order Type
RFP 9227 CM/GC Services for Lemay Ave Realignment over the BNSF Railroad Tracks and Vine Dr Page 32 of 123