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olorado pF CpP <br /> rocurement ti <br /> egistry STATE OF COLORADO N�� �'�0 <br /> Procurement Registry <br /> Lffr11k6__!df or Colorado Business �F 1876 <br /> c m isuppmsmkes coksd offtmacud ration <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 FEIN <br /> List dba, if any <br /> 2. Mailing address <br /> City 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.dora.state.us/Certification/sic.htrn) <br /> 7. Ownership information (use additional pages if necessary): <br /> L�, T t tAh1E ItST N % GENDjE C <br /> i. <br /> h/ <br /> �S• <br /> � � „oF � 1Sat1 c � spantc <br /> t t1 SpaXtt ��Q <br /> �� ,, � � a\�� , ....a 1 � 2 v� p � eft � �.. �' • ;,,,,,, <br /> 8. Is your company registered on the BIDS system? YF] Nn. <br /> Signature Title Date <br /> Visit these web sites for information on BIDS:www.Qssa.state.co.us;DBE Certification:www.dora.state.co.us/Certification <br />