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ent <br />Rosiness <br />c +ns~pasa.~ ~~a~.~un~+cona~~ <br />STATE OF COLORADO <br />Procurement Registry <br />The State of Colorado, through its Department of Regulatory Agencies, maintains a master list of firms that may be used in the State's <br />discretionary procurement process. The list is posted on our web site for use by all State employees who make purchasing decisions. <br />By completing this form and returning i[ with the requested documents, your fum will be registered on that list. If this form is <br />returned incomplete or without the supporting documents your fum may not be registered. Questions about the registry should be <br />directed to (303) 894-2355. Please return the completed form and requested documents to: <br />Division of Minerals and Geology <br />1313 Sherman St., Rm. 215 <br />Denver, CO 80203 <br />I. Legal Name of Business <br />List dba, if any <br />2. Mailing address , <br />City <br />FEIN <br />State Zip + 4 <br />3. Business phone Fax <br />4: E-mail address Web address <br />5. Name of Contact person: Last First <br />6. Type of work the company performs (use sic codes found at www.dorastate.us/Certificafion/sic.htm) <br />7. Ownership information (use additional pages if necessary): <br />Signatwe Title Dale <br />olorado <br />rocurem <br />l egistry <br />m~ to. calaad~ <br />vicit These web sites for information on BIDS: wwwsssastate.co.us; DBE Certification: wvnv.dorastatc.co.usfCertification <br />8. Is your company registered on the BIDS system? Y^ N^. <br />