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olorado pF Co <br /> roce i�ment STATE OF COLORADO <br /> Procurement Registry ° <br /> ■ 6 for calara&Business <br /> f876 � <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 State Zip+4 <br /> 3. Business phone Fax <br /> 4: E-mail address Web address <br /> 5. Name of Contact person: Last First <br /> 6. Type of work the company performs(use sic codes found at www.don.state.us/Certification/sic.htm) <br /> 7. Ownership information (use additional pages if necessary): <br /> .3 NM �.PWAY- (__._;`*BU V <br /> :- .�.»,.. ...�oaw -;tones*°� -�-� •�° oi!` con- ,� �. - <br /> � <br /> .,;r��,t_•���. .. •''• .re• laG .. ,• .»-,.., .ems..•'�.w.vu� <br /> 8.• Is your company registered on the BIDS system? YQ NE]- <br /> Si-nature Title Date <br /> vatic these web sites for information on BMS-.www.essa.state.co.us;DBE Certification:www.doca.ststc.co.us/Certification <br />