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olorado <br />rocurement <br />egistry <br />for Colorado Business <br />Cam' H9exe CakNad0Ut1M%4CCMfiCM)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 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 g4-1038618 <br />1. Legal Name of Business Palisade Constructors, Inc. FEIN List dba, if any <br />2. Mailing address <br />City <br />3. Business phone <br />4. E-mail address <br />695 36 Road <br />Palisade <br />970/464-7371 <br />State CO Zip + 4 <br />Fax 970/464-7569 <br />Web address =/ a_ <br />81526-8767 <br />mikepci@aol-com <br />Cunningham First Mike <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.htrn) <br />7. Ownership information (use additional pages if necessary): <br />Fzxsrxar MIDDLE GENDER/TYPE ' ETmmcrry <br />I <br />n4MAL ' (sue*' ELOw) (sue BELOW) <br />Lis*xv <br />Cunningham <br />Cunningham <br />J R <br />-- 1 52 I M I WH <br />Gender/Type codes .Male .. Etfioicity'codes Ht anic HI <br />Asian Pacific .... AP sp <br />Female ....... F BL White (non Hispanic) . WH <br />Owned by Tribe ., ..... T Black <br />Native American'... NA Other ...:.. ............. OT <br />Publicly held ........ P - <br />8. Is your company registered on the BIDS system? Y® N?. <br />Title <br />I Signature <br />Date ?I -.,) % 671!51 <br />Vi-it these web sites for information on BIDS: Mn p ssa.state.co.us; DBE Certification: www.dora.state.co.us/Certification