Laserfiche WebLink
_,Name of Com a� ny: ��! r� — <br />Pre -Qualification Category <br />Second Opinion Excavation Special <br />❑ <br />Attach copies of the following <br />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 <br />Pzinci aI Place of <br />Business: ........... <br />�p _ 0 c <br />A � �� � <br />Mailin "°g...A_.- _�.......-._ <br />ddress. <br />� . _� ........ <br />I�r� <br />p <br />T �� Im �`7;a I <br />1� .� Fa � �._ ..... ..... E-Mat <br />Ownership Information <br />(Identify all owners iflhe <br />Company, ifapplicable) <br />_._.... <br />Nature of Company's <br />BusinessDA <br />,_ .. ........... .. __,........................ ........... <br />�/tt C <br />(OXYt "S C.C.S <br />(Briefly describe the flee of <br />servicesyoea-conopanyprovider) <br />pUs, j r lL1L_� <br />X <br />(Provide references as needed to <br />validate erperience forspecffic <br />p)e-gaalifcafioa) <br />o mpetent Person <br />Certification. � _ <br />........... _ .... <br />nn ---- <br />(Naineofholder, expiration date) <br />11C CV <br />13 <br />