)
& & & & && & & & & & &
) ) ) ) ) ) ) ) ) ) ) )
) ) ) )
)
) )
) ) ) )) ) )
)) ) ) )
) ) ) )
) ) ) )
) ))) ) ) ) ) )
))) ) ) ) ))) ) ) )
)
) ) ) ) ) ) ) )
) ) ) ) ) )
)
)
) ) ) ) ) ) ) ) ) ) )
&
& &
& &
&
)
) )
) )
) ) ) )
& & & & &
& & &
& & &
& & & & & &
& & & &
Community Planning & Development
Office of the Manager
Contractor Licensing
201 W. Colfax Ave., Dept. 205
Denver, Co 80202
Phone: 720.865.2770
www.denvergov.org/contractor_licensing
!"#$%&%'($e *"+",(l ./#0
Please&fill in your Certificate&information below. (This information can be&found on your current Cer tific a te ca rd )
1+-2 ( '"#$%&%'($" 3/-4"# %5 6"#0%$$"4 $/ 5780%$ '3(+9"5 /& '"#$%&%'($" %+&/#0($%/+:
;-"(5")%+4%'($")(+2 (+4 (-- '3(+9"5
82 '3"'<%+9)$3")=8/>?e5@A:
B(0" /& !"#$%&%'($" C/-4"#D
E44#"55D
F0(%- E4 4#"55D
;3/+"D !"-- ;3/+"D
!"#$%&%'($")B708"# !"#$%&%'($")G26" F>6%#($%/+ H($" E0/7+$ H7"
Please notarize and submit a copy of your Secure Verifiable Identification (this is your Driver License, ID Card,
Passport, 1551 Permanent Resident Card, etc). You may view entire list of acceptable IDs on the
Affidavit of Lawful Presence on our website: www.denvergov.org/contractor_licensing
;-"(5")5"+4 $3%5 &/#0 (-/+9 ,%$3 6(20"+$: .""5 &/# '"#$%&%'($"5 (#" (5 &/--/,5D
I7 6"#J%5/#- $60
J/7#+"20(+ - $40
16"#($/# - $40
I$($%/+(#2)F+9%+""#- $40
!"#$%&%'($")C/-4"#'5 I%9+($7#"
G%$-" H($"
*"0%$ $/D
K(<" '3"'<5 6(2(8-" $/D
City and&County of Denver
“Manager of Finance”
Contractor Licensing
201 W. Colfax Ave. Dept 205
Denver, CO 80202
click to sign
signature
click to edit