Laserfiche WebLink
Cot <br /> rralo <br /> ocurement — —0� <br /> rocureegistry STATE OF COLORADO N�%" _ . ' 90` <br /> Procurement Registry *� <br /> for Colorado Business 1876 <br /> n� tr' <br /> CcrcnlArypKt 4rvka CaWraJn OlflaMCcnlfkatwn <br /> .i <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 <br /> State Zip+4 <br /> 3. Business phone Fax <br /> 4. E-mail address Web address <br /> 5. Name of Contact person: Last <br /> First <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 /> L+ yMII7DLE' °l sawrtm ,�ErmEtUTxr �rEcmr = <br /> LnsTtaNns � W � �� c II3TrIAI (5)E•BEIA (., >, <br /> @ CO(ICS # Male �s 51yj v�)H tttlCit}'CO(�C9 <br /> ° � Gender/Typ u, w 8� � llltC(nOn�11sp811Yc) <br /> I <br /> 8. Is your company registered on the BIDS system? Y❑ N[� <br /> Signature <br /> Title Date <br /> Visit these web sites for informatio on BIDS:www Qssa.state.co.us;DBE Certification:www.dorastate.co.us/Certification <br /> I <br />