Laserfiche WebLink
STATE OF COLORADO <br />Procurement Registry <br />r cda.tl. ~.rNn~ <br />c+..r«ai~~o. <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 it with the requested documents, your firm will be registered an that list. if this form is returned <br />incomplete or without the supposing documents your firm may not be registered. Questions about the registry should be directed to <br />(303) 894-2355. Please return the completed form and requested documents to: <br />Division of Minerals and Geology <br />1313 Sherman St., Rm. 215, Denver, CO 80203 <br />I. Legal Name of Business <br />List dba, if any <br />2. Mailing address <br />FEIN <br />City State Zip+4 <br />3. Business phone <br />4. E-mail address <br />5. Name of Contact person: Last <br />Fax <br />Web address <br />First <br />6. Type of work the company performs (use sic codes found at www.dora.state.us/Certification/sic.htm) <br />7. Ownership information (use additional pages if necessary): <br />9. To verify gender and ethnicity, submit a copy of one of the following for each owner : birth certificate, driver's license, passport, <br />or certification of naturalization. If the firm is SBA 8(a) certified submit a copy of the letter of acceptance. <br />10. To verify ownership submit a copy from the following list of acceptable documents based on the company's legal structure: For <br />sole proprietorships - a trade name registration or schedule C; For partnerships, LLCs , or S corporations -schedule K-l from <br />your firm's federal income tax returns; and for Corporations page #2 from the corporate tax returns. If the firm is SBA 8(a) <br />certified submit a copy of the letter of acceptance. <br />Signature Title Date <br />Visit these web sites for information on BIDS: www eua <tate.co_us; DBE Certifica[Ion: www.dora.state.co.uc/Certification <br />8. Is your company registered on the BIDS system? Y~ NQ <br />