The information shown below is true and correct for the Contracting Entity and all owners of 5% or more of the Contracting Entity and, where the Contracting Entity is a non-profit entity, the required information has been shown for each officer, president, vice-president, secretary, treasurer, etc. [NOTE: IN i.e., ALL CASES, USE FULL NAMES, LOCAL DO BUSINESS AND RESIDENCE ADDRESSES AND TELEPHONE NUMBERS. NOT USE POST OFFICE BOXES FOR ANY ADDRESS. INCLUSION ATTACH OF E-MAIL ADDRESSES IS OPTIONAL, BUT RECOMMENDED. ADDITIONAL SHEETS AS NEEDED.] Contracting Entity Name: Business Address [NO./STREET] CODE] [CITY/STATE/ZIP Telephone Number ( _) Address [OPTIONAL] Residence Address [NO. /STREET] [CITY/STATE/ZIP CODE] Telephone Number ( _) Email Address [OPTIONAL] 5% Owner(s) or More (IF “NONE.”) NONE, STATE Name: Business Address [NO. /STREET] [CITY/STATE/ZIP CODE] Telephone Number ( _) Email Address [OPTIONAL] Residence Address /STREET] [NO. CODE] Telephone Number ( _) Email Address [OPTIONAL]
The information shown below is true and correct for the Contracting Entity and all owners of 5% or more of the Contracting Entity and, where the Contracting Entity is a non-profit entity, the required information has been shown for each officer, i.e., president, vice-president, secretary, treasurer, etc. [NOTE: IN ALL CASES, USE FULL NAMES, LOCAL BUSINESS AND RESIDENCE ADDRESSES AND TELEPHONE NUMBERS. DO NOT USE POST OFFICE BOXES FOR ANY ADDRESS. INCLUSION OF E-MAIL ADDRESSES IS OPTIONAL, BUT RECOMMENDED. ATTACH ADDITIONAL SHEETS AS NEEDED.] Contracting Entity Name: Business Address [NO./STREET] [CITY/STATE/ZIP CODE] Telephone Number ( _) Address [OPTIONAL] Residence Address [NO. /STREET] [CITY/STATE/ZIP CODE] Telephone Number ( _) Email Address [OPTIONAL] 5% Owner(s) or More (IF NONE, STATE “NONE.”) Name: Business Address [NO. /STREET] [CITY/STATE/ZIP CODE] Telephone Number ( _) Email Address [OPTIONAL] Residence Address [NO. /STREET] CODE] Telephone Number ( _) Email Address [OPTIONAL]
PCMS%20Word%20Version%20of%20Required%20Forms.docx