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Page 1 01, 1 <br /> MlNNI `o IA- KI VI Ntll <br /> Contractor Affidavit Submitted <br /> Thank you,your Contractor Affidavit has been approved. <br /> Confirmation Summary <br /> Confirmation Number. 1-776-332-672 <br /> Submitted Date and Time: 6-Oct-2015 1.03:15 PM <br /> Legal Name: FAHRNER ASPHALT SEALERS LLC <br /> Federal Employer ID: 11-3804531 <br /> User Who Submitted: 8753003 <br /> Type of Request Submitted- Contractor Affidavit <br /> Affidavit Summary <br /> Affidavit Number: 99762176 <br /> Minnesota ID. 8753003 <br /> Project Owner, CITY OF CENTERVILLE <br /> Project Number: 2013 ST IMP <br /> Project Begin Date: 11-Oct-2013 <br /> Project End Date, 25-Aug-2014 <br /> Project Location. CITY OF CENTERVILLE <br /> Project Amount: $17,290.24 <br /> Subcontractors: No Subcontractors <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-rree)800-657-3594,or(email) <br /> With holding,tax@slate.mn us_Business tours are B 00 a.m -4.30 p.m.Monday-Friday <br /> Please pprlt Jq pagsr for your records using the print or save functionality built into your browser <br /> lit tps:8,AAm,.Inndur.state.mn.USAP/escrvices/ 10'6/201, <br /> 95 <br />