<p> Facilities Planning and Management Construction Services 200 General Services Building 700 Wallace Road Ames, IA 50011-4013 Phone: (515) 294-0563 Fax: (515) 294-2764 E-Mail: [email protected]</p><p>PROJECT INFORMATION & CONTACT LIST Name of Project: Use project title as exactly on award letter or contract Bid Package Number or Phase:</p><p>Iowa Sales Tax Exemption Certificates will be prepared by the Owner for the Contractor and Subcontractor(s) listed on this form. Include parties who will be purchasing material for this project. The Owner will generate the Certificate(s). The Certificate(s) will be sent to the Prime Contractor for distribution. Return this form by e-mail at the address above</p><p>Prime Contractor: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Project Manager: Project Manager E-Mail Address: Superintendent: Superintendent E-Mail Address: Superintendent Cellular Phone #: Site Phone #: Safety Representative: Safety Representative Phone #: Primary Emergency Phone #: Contact: Secondary Emergency Phone #: Contact: (Not required if Primary is answered 24 hours)</p><p>Check here if no subcontractors will be used: ISU USE Tax Exempt Entry & : ONLY: Certificate Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate: Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate: Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate: Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>Subcontractor: Does this company need access to Centric Project? Yes No </p><p>Section & Description: Iowa Contractor Registration #: Federal ID #: Street Address: City, State, Zip: Office Phone #: Fax #: Emergency Contact: Phone #: Primary Contact & Title: E-mail Address: (Required for access to Centric Project) Type of work: Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition Material Supplier Only (Other) Other: Specify: Comments: </p><p>ISU USE ONLY: Tax Exempt Entry & CP Set Up: Certificate:</p><p>D:\Docs\2017-07-17\09787041b9c50cefc234eebb4870c98a.doc</p>