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EUlinnesota Department of Labor Hnd Industry I_icensinc�and �erti(icatlon Services
<br /> Conslruction Codes and Licensing Division Phone: +3;1.2II4.503�1
<br /> 443 Lafayette Roed N Email: DLLlicense(a�state.mn.us
<br /> Saint Paul, MN 55t55 Website; www.dli.mn.�ov/ccld.asp
<br /> NOTICES
<br /> NOT TRANSFERA9LE
<br /> CHANGE YOUR BUSINESS STRUCTURE PELLA NORTI-ILl1
<br /> SUBMIT A NEW AI'PLICATION FOR NEW ENTITY
<br /> 15300 2 AVE STE 100
<br /> RENEW OR REPLACE INSURANCE POLICY PLY UTI-I, MN 554�17
<br /> SUBMIT NEW CEf�TIFICATE OF INSURANCE
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<br /> NOTIFY TFIE DEP/1tZTMENT OF !! Ct�l/�NGL IN YOUF� BUSINESS. � /l �jl � � �
<br /> Failure to do so, s+.jbjects you lo administrative penalti�s of up to $10,0 t
<br /> !`i-Day N�tice f7equirement--Fornis availr�Ule onl�ne at www_dli^mn��oy/CCLD/LicUlxlat s��
<br /> . r;hanqe in b���>inr��,,�;' �:�liysic;ril ailcire:���,rn�iilinc� address,��lione numl�^r. r�r em�il ;idclres,;
<br /> • i;h;in�e�n c,oiilrol, owrir-;r:�, r-i((icrns, directars, f11rr77�efs.partners
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<br /> a i•h,�nc���in Inisi�ir,r,s Icr�„i ri,:un�:�:inc:l/or�:tss�arncdn,.:une
<br /> • I o�;•:ril or r:l�;uii�rr iii tJI.I,�Lll�=1'INC'� f3Ull_D1.=Fi
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<br /> I��uii.�ciiatc Nali<:c Fir_qulr�n�enl--fJotitic..�iian to DLI in writing
<br /> - .liiii��irtc•nt f:)nl�t�.;r. .n lieensr:d .r,c>nlr:�cic�r h�s 15 day^, la provicic� wrillr��n no(ice c.�l lPi�i fincline Ifi;t� it is lound lo bo a judqrnenl
<br /> rlc��t��or f��,�s�.>ri ���x;n cnnrl��c:!rc�c�uninc) licens�.irr...
<br /> • I;arilvu��l�:y Pr�tilir�n 1 ilr:�cl /1 lic;c:�ri�;�d r,or7U�ar.lor Ii�s 1'�dr�ys tc�providr, �vrill�n nolice th�.it it liled a pelition (or bankruplcy.
<br /> �� e::;oiivir.,�ion Nnlicc /� lici�ns;ed r,or�lr<+r..tor h::is 10 d�ys lo provicJe wriU�n nc�lice Ihnt il h�s bcen found guilty ol a lelony, gross
<br /> �iiisdrririr:r.u�oi, ir�isdc+rne,ini�r or any comparable of�rnse relalecl lo Ilie li.r,en,��, inr;luding convictions ol fraud,
<br /> �nisrepres�?nl,�lie�i�, n7isii�;e c;i funcis, Ilicll, ..r,rii7iin�l sexir:�l eanduc:t, �s��iulL I�i,irc�l;ir��, r.onverrii�n of funds, or thelt ol pror_eeds
<br /> in Ilii��nr nny r;llie�r sl;�Ir� �:�r ;iiiy olhrr l.Jnit�.-�d S(ales ji.irisdir.tior�.
<br /> YC:iUff �:EFiTIFIC/1'�1= IS fi1:L.C1W �fl)(_ PERF=ORAI"IOPJ. SI10W CE.FiTIPI�/1TF.':WHEN OE3TAINING PEFlMITS.
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<br /> i�#�y Ul�OI'� 13c INI7USTI�ti'
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<br /> ��nii�lcinrr ��ith A-tinm•snia .`;lalulr.,< ;?(�It.h11;, :inil in�i�� buil�l rr:;i�.l�•iili:il rral rslntc, c��nlr:irt ur��fl'rr I����niiu:�ct �vi�h an n«mcr lo bnil�l
<br /> ��,i,l�nu.il rc;�l rsl:� �. .niJ rununrl ��r��Ili•r i�� ��nnUai•1 �ti1h ,in oa�ni:r Ic, iittrrcivc cxislint?r��si�iirnli:il rc?:il cs1:Uc; ��r���•idccl 1!ic
<br /> ���.��,�;,,:il�lr ivulu;il is :it ;ill linii•s ,i �;)11,11.11�1'IN(.i [il lll.l)f�:R micl Ihcrcrlitic:ur h��liJrr m;iintains r�,ni��linncc� �vilh Ih�.�rcquircd�,cncral
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<br /> L�r.ens� : 12FSIDrN�fl/1L f3LDG CONTRACTOFa i
<br /> Ln:. P�Umbrr : ifL;G�t'.iu'::�Ci f'I_I_.I_/1 NOHT"f-ILANf_) �
<br /> f Jf�rc ivc Datr. : �'11;:'7;'::'I')1::' 1_`i3C)O 25 fl�I /1V� �l F l Of_1 f3
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<br /> t x�:�irali n [)3IL' ; !1;S/;�I/..�Ol;i I'I YMOUTf-I, MN �i'i�147 C
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<br /> ':�f_f{IPY UP-TU-DArf.-: ST'/�TU`i, f30ND, AND INSURANCEINFO ATwww.dli_mn.,c�r�v/c;cl.d/LicVerify..is�� (rNTER NUMBER).
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