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m Naaae of _.-Gr e c xc cxya i � h <br />Pre Qualification Category <br />Second Qpiinion Excavation Sp al <br />Attach copies of the followm ' g do cuments <br />I. 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 Business: 30416 _ (o CvnA-y Roo, ,... 24 <br />©5Ge_010.1 W + 5(91 <br />Mailing Address: A 304 q 5 _ & Co\i M-Y toga Zf ' <br />O sr ec� la ( /A/ 4loslo <br />Te➢ laoa Cell Fax: I <br />c <br />()wncrsbip Information 11- j /7 Company, l i(applicable) bl)e Pn e 1 Cm none <br />Co an , : a livable c <br />Nature of Company's . <br />.. <br />Business &rrVe EXr,, <xA- a &Y\ eY (A1\1A -" Tas:6r <br />(Briefly describe the type of ` <br />servicesyourcompanyprovides) �1 f rry <br />(Provide references as needed to <br />validate experiencefor specific q �' <br />pre -qualification) t 1tMa a f' 11a I� 4ak,%r..a6*'t) <br />OSHA Competent Person <br />Certification P a7Trp1f� <br />(Name of holder, expiration date) r� <br />05VA 40 <br />*14s?tFl <br />7J 1 9 <br />13 <br />