GENERAL53880

• Permit No: C1981015
• IBM Index Class Name: General Documents
• Doc Name: BID FRUITA MINE AMERICAN SHIELD BOND FORFEITURE
• Permit Index Doc Type: GENERAL CORRESPONDENCE
• Media Type: D
• Archive: No

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STATE OF COLORADO
Procurement Registry
The State of Colorado, through its Department of Regulatory Agencies, maintains a master list of firms that may be used a the State's
discretionary procurement process. The list is posted on ow web site for use by all State employees who make pwchasing decisions.
By completing this form and returning it with the requested documents, yow firm will be registered on that list. If this form is
rerumed incomplete or without the supporting documents your firm may not be registered. Questions about the registry should be
directed to [phone]. Please return the completed form and requested documents to:
Division of Minerals and Geology
1313 Sherman St., Rm. 215
Denver, CO 80203
1. Legal Name of Business
List doer, if any
2. Mailing address
City
3. Business phone
4. E-mail address
5. Name of Contact person: Last
State Zip+4 _
Fax
Web address
Fast
6. Type of work the company performs (use sic codes found at www.dory.state.us/Certification/sic.htm)
7. Ownership information (use additional pages if necessary):

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8. Is your company registered on the BIDS system? Y^ N^.
Signature Title Date
alarado
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egistry
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FEIN
vicar these web sites for infortna[ion on BIDS: www.essa.state.co.us; DBE Certifies[ion: www.dora.state.co.us/Cenificafion