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i <br /> Page I of 1 <br /> I <br /> MINNESOTA-REVENUE <br /> Contractor Affidavit Submitted <br /> Thank you,your Contractor Affidavit has been approved. <br /> Confirmation Summary j <br /> Confirmation Number. 0-310-634-368 <br /> Submitted Date and Time: 19-Aug-2015 7:19:40 AM <br /> Legal Name: VALLEY PAVING INC <br /> Federal Employer ID: 41-1348160 <br /> User Who Submitted: ValleyPavingTax <br /> Type of Request Submitted: Contractor Affidavit ' <br /> I <br /> Affidavit Summary <br /> Affidavit Number: 852049920 <br /> Account Number: 5565541 <br /> Project Owner: CITY OF CENTERVILLE <br /> Project Number: 15-06 <br /> Project Begin Date: 04-May-2015 <br /> Project End Date: 31-Jul-2015 I <br /> Project Location: CENTERVILLE OVERLAYS j <br /> Project Amount: $220,052.75 <br /> Subcontractor Summary <br /> Name ID Affidavit Number <br /> WARNING LITES OF MINNESOTA 3086922 1736196096 <br /> CENTRAL LANDSCAPING 7663076 295649280 <br /> i <br /> STAPF CONCRETE CONSTRUCTION 6036685 387792896 <br /> Important Messages <br /> A copy of this page must be provided to the contractor or government agency that hired you. <br /> Contact Us <br /> If you need further assistance,contact our Withholding Tax Division at 651-282-9999,(toll-free)800-657-3594,or(emall) <br /> Wlthholding.tax@state.mn.us.Business hours are 8:00 a.m.-4.30 p.m.Monday-Friday. <br /> Please print this confirmation page for your records using the print or save functionality built Into your browser. <br /> i <br /> i <br /> i <br /> i <br /> i <br /> I <br /> I <br /> I <br /> I <br /> i <br /> i <br /> 1 <br /> https://www.mndor.state.mn.us/tp/eservices/ /Retrieve/O/b-/3Fzed_eSRIIWSQOcGT23hA... 8/19/2015 <br /> 33 <br />