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olorado <br /> rocurement ' OF Cpt.0 <br /> egistry STATE OF COLORADO <br /> Procurement RegistryLl <br /> �) <br /> rB1a d for Colorado Business <br /> Gaittl Suppn vnYe, eobrmn�x�,�ewurm `876 <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 /P_0 Ni I A/if— FEIN <br /> List dba,if any / <br /> 2. Mailing address YdS • /7 �d�! <br /> City brh .,_ State _ Zip+4 <br /> 3. Business phone eJ7010 g Fax 970—a5F-73 3 j <br /> 4. E-mail address_ it+hir-on AQl_.Co rr Web address <br /> 5. Name of Contact person: Last C V_, First Ya Ya I" , <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 /> So I <br /> <, a. �ritID 1'�7ICIIYSP <br /> r w (sue*Brzow <br /> Fr%cAc 51% F W# <br /> ckl S 41 q °/p W 4f <br /> t6nrct lodes. <br /> •em a :� 4' � am � _`. <br /> v _..;.. non LspanrcH <br /> - <br /> . <br /> r_ <br /> 8. Is your company registered on the BIDS system? YN NQ. <br /> Signature '' Title Date <br /> -" .�._.._.._— ..,. DTTC•....-,.nee♦�,,,P,.,,,,V nRF Certification:www..domsmte.co.us/Certification <br />