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Pre -Qualification Category <br />Second Opinion Excavati Special <br />❑ ❑ <br />Attach copies of the following documents: <br />1. License Number <br />2. Bond letter stating limits for single project and aggregate program <br />3. (Corp. or LLC Only) Corporate authority and/or proof of registry with the Secretary of State to <br />do business in Indiana <br />Principal Place of <br />Business: <br />2 <br />lam/ 1 %%� ���� <br />Mailing Address: <br />Telephone: <br />Cell: Fax: <br />E-Mail: <br />Ownership Information <br />(Identify all owners if the <br />Company, i(applicable) <br />Nature of Company's <br />Business <br />cribethetypeOf <br />l% f� ' <br />awe [V K lows') d cmo <br />services your company provides) <br />(Provide references as needed to <br />validate experiencefor specific <br />pre -qualification) <br />OSHA Competent Person <br />Certification <br />(Name of holder, expiration date) <br />OSHA Confined Space <br />Training Certification <br />(Name of holder, expiration date) <br />V-? <br />16 <br />