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olorado <br /> rocurement OF COL <br /> egistry STATE OF COLORADO <br /> Procurement o <br /> n *� <br /> L for Colorado assi m, <br /> c s R .�.. cmwoc acaur mo. *IS 716 it <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 firn 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 Charles-W. Sickles Construction FEN 84-1439993 <br /> List dba,if any <br /> 2. Mailing address P.O. Box 91 <br /> City Hotchkiss State CO Zip+4 81419 <br /> 3. Businessphone (970-) 872-4889 Fax (970) 872-4890 <br /> N <br /> 4. E-mail address Web address <br /> li <br /> 5. Name of Contact person: Last Sickles Fit Charles <br /> 6. Type of work the company performs(use sic codes found at www.dora.state.us/Certification/sic.htm*)__.E�xcavat ion <br /> 7. Ownership information (use-additional pages if necessary): <br /> Sickles r rCharles !! W 100% M WH <br /> 8. Is your company registered on the BIDS system? Y® NQ. <br /> S' � <br /> r nature <br /> g Title <br /> Owner Date <br /> 9/13/99 <br /> Visit these web sites for information on RM9-www.o_ssa.%mte.co.us:DBF rortmrariftw An«. <br /> II <br />