SCC and DPOR Information

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SCC and DPOR Information

ATTACHMENT 3.2.10 State Project No. 0007-253-009 SCC and DPOR Information Offerors shall complete the table and include the required state registration and licensure information. By completing this table, Offerors certify that their team complies with the requirements set forth in Section 3.2.10 and that all businesses and individuals listed are active and in good standing.

SCC & DPOR INFORMATION FOR BUSINESSES (RFQ Sections 3.2.10.1 and 3.2.10.2) SCC Information (3.2.10.1) DPOR Information (3.2.10.2) DPOR DPOR Business Name SCC Type of SCC DPOR Registered DPOR SCC Number Registration Registration Corporation Status Address Expiration Date Type Number

1 of 2 ATTACHMENT 3.2.10 State Project No. 0007-253-009 SCC and DPOR Information DPOR INFORMATION FOR INDIVIDUALS (RFQ Sections 3.2.10.3 and 3.2.10.4) Office Location Where Professional Individual’s DPOR DPOR DPOR Registration DPOR Expiration Business Name Individual’s Name Services will be Address Type Number Date Provided (City/State)

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