Laserfiche WebLink
olorado OF'COl\ <br /> rocurement <br /> egistry STATE OF COLORADO <br /> Procurement Registry ` <br /> RL for Colorado Business I876 <br /> Ca'ntal5uppv�:avka Cak d0C�dCcMh,.W., <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.dora.state.us/Certification/sic.htm) <br /> 7. Ownership information (use additional pages if necessary): <br /> ,� �a "� •�� � . �r "MB7IIIE;:% t , � T_ ; <br /> MY. 1;1' I a�flAiEUSNAME : <br /> s' sc�� t,,;�• "C <br /> Gender/T7T�1p'codes'*a Male" '`" tonic <br /> ,"e ,;s, * ` .�''-, .$rc "_+ <br /> ...'°t S. /.a' :iW :dat'�'-.'s=K• ee^&'a :.2.$ ..w''°.i'� `iu?:e4�"",p-.x �.r�,'•,`.r„k"fsre„y} {�: sn� <,k' - ,d C�roq✓v 6 ,,".'.'mn's <br /> "'Ce9:dt -'p'24��Nn":Y°%t . a„&�a�"+ S.f 9r��.�'.�-' ^d'FiW ;C�w�1V'.�.'S:.�a.s.'. - i:•.^,�..niC'�L-'�3 a.,, �:� fac+YM:.� •��,. <br /> �',. �� ;��� �:f; °°�'�f)wned �I"ntiez-:����;`T>� .� �.Blaclr`'=` _Bb;e•�. >�VVJiite;{tioit=Hispanic} <br /> "'I'itlilicly:heXd r P' `Native'American+s-. OT: <br /> 8. Is your company registered on the BIDS system? YF� NF�. <br /> Signature Title Date <br /> visit these web sites for information on BIDS:www.rssa.state.co.us;DBE Certification:www.dora.state.co.us/Certification <br />