Laserfiche WebLink
olorado <br /> ' rocurement <br /> ' egistry <br />Ll <br /> <br />ib- for Colarado Business <br />.,?? e?u??noiav,+eeninrm? <br />?n <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 snake 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 <br />List dba, if any <br />2. Mailing address <br />FEIN <br />State Zip + 4 _ <br />City Fax <br />3. Business phone <br />Web address <br />4. E-mail address <br />First <br />5. Name of Contact person: Last <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 />1% inoir: °o 0W? E? 5ENDER/T'PE ETt4mi <br />LAST N EMI: FIRST N:11tE <br />INITL4L "SEE* BELOW) - (5 <br />Gender/Typc codes * ?B4ilC Ethnicity codes **. <br />Female :.....nb.c : F Asian Pacific .... AP Hispam c HI <br />BL W'hite (non Hispamc) <br />0w1 ed by <br />Tlati?e.Amaican NA Other................. .. OT <br />PubLcl} l T T Blac} <br />lcld P <br />8. Is your company registered on the BIDS system? Y? N? <br />Signature <br />vii t these web sites for <br />Title <br />Date <br />on on BIDS: -.sssa.state.co.us; DBE Certification: www.dora.state.co.us/Certification