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03/02/00 11:57 FAX 9702412832 WC REAL ESTATE M 1607 <br />CONTRACTOR STATEMENT OF EXPERIENCE <br />STATE FORM SC-9.1 <br />MMBE SELF CERTIFICATION <br />In an effort to track levels of participation by women and minorities in construction for the State of Colorado, <br />the following information is requested. Please indicate the appropriate category of ownership for your <br />company. 'Owned" in this context means a business that is at least 51 percent owned by an individual(s) <br />who also control(s) and operate(s) it "Control" in this context means exercising the power to make policy <br />decisions. "Operate" means actively involved in the day-today management If "Other" please list what the <br />other is. <br />K. Female-Owned <br />O African American <br />0 Hispanic American <br />SERVICES PROVIDED <br />13 Male-Owned <br />10 Asian/Pacific American O White (non-Hispanic) <br />O Native American 0 Other_ <br />If you are a General Contractor interested in bidding on all types of building construction, check the box 'All <br />classes of Construction." If you are interested in contracting directly with the State for certain types of work <br />only, check box as per Construction Specifications Institute (CSI) divisions. If you wish to list specific <br />categories in the divisions please use the five (5) digit number and title per CSI format in space provided <br />below. <br />13 DIVISION 01-GENERAL REQUIREMENTS 13 DIVISION 09-FINISHES <br />h"IVISION 02-SITEWORK 0 DIVISION 10-SPECIALTIES <br />13 DIVISION 03-CONCRETE 0 DIVISION 11-EQUIPMENT <br />13 DIVISION 04-MASONRY O DIVISION 12-FURISHINGS <br />0 DIVISION 05-METALS 0 DIVISION 13-SPECIAL CONSTRUCTION <br />O DIVISION 06-WOOD & PLASTIC 0 DIVISION 14-CONVEYING SYSTEMS <br />E3 DIVISION 07-THERMAL & MOISTURE 0 DIVISION 15-MECHANICAL <br />O DIVISION 08-DOORS & WINDOWS 17 DIVISION 16-ELECTRICAL <br /> 0 ALL CLASSES OF CONSTRUCTION <br /> i* ?YN 1+ 107?I? <br /> <br />Submit completed form to State Buildings Programs at 1525 Sherman St. Ste 250, Denver, CO 80203. <br />DATE RECEIVED AT SBP-. <br />State Form SC-9.1 <br />Revised 12/99 <br />2 of 2 <br />1 7 <br />Name (typed or printed) Title