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oloradoroc OF Cp <br /> egis�y ent STATE OF COLORADO Q`r l° <br /> 0 <br /> Procurement Registry <br /> LIAhh— forCelarinio Business <br /> Cmatal5u"xt5wd= CabradoU mr4Cadca1Wn 1876 <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 on that list. If this form is <br /> returned incomplete or without the supporting documents your firm 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 /> 1. Legal Name of Business Cp I©Rr-,d 0 (/U 2 S fi /,R.A S /t yG FEIN <br /> List dba,if any <br /> 2. Mailing address 2Ll <br /> City R,Al U State C,0 Zip+4 <br /> 3. Business phone 9 70- 7 1/' S 7 Fax C/70— SZ 3-0 6 S 0 <br /> 4. E-mail address Web address <br /> 5. Name of Contact person: Last /� S �_ First PR,C_ lO A/ <br /> 6. Type of work the company performs(use sic codes found at www.dora.state.us/Certification/sic.htm) 6 e_S <br /> 7. Ownership information (use"additional pages if necessary): <br /> M <br /> AA&+5� RE Cf C( <br /> s <br /> 8. Is your company registered on the BIDS system? YN NF�. <br /> Signature Title , Date <br /> �r <br /> Visit these web sites for information on BIDS:www.assa.state.co.us;DBE Certification:www.dora.state.co.us/Certification <br />