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MN e -Services <br />Contractor Affidavit Submitted <br />1€f*xfTt1fka'n Fti+'ilwu "I r -',bruit compute <br />Thank you, your Contractor Affidavit has been approved, <br />Confirmation Summary <br />Confirmation Number: <br />0-976-625-408 <br />Submitted Date and Time: <br />8 -May -2015 10:38:10 AM <br />Legal Name: <br />ROCHON CORPORATION <br />Federal Employer ID: <br />41-1 51 9922 <br />User Who Submitted: <br />Rochon <br />Type of Request Submitted: <br />Contractor Affidavit <br />Affidavit Summary <br />4797684 <br />Affidavit Number: <br />2142339072 <br />Account Number: <br />3315692 <br />Project Owner: <br />CITY OF NEW BRIGHTON <br />Project Number: <br />1417 <br />Project Begin Date: <br />01 -Sep -2014 <br />Project End Date: <br />01 -Mar -2015 <br />Project Location: <br />NEW BRIGHTON COMMUNITY CNT 400 10TH ST NW NEW BRIGHTON MN 55112 <br />Project Amount: <br />$706.80000 <br />Subcontractor Summary <br />Name ID Affidavit Number <br />MIDWEST SPECIALTY MAINTENANCE INC 8084566 212221952 <br />LLOYDS CONSTRUCTION SERVICES INC 3909541 2105819136 <br />KELLEHER CONSTRUCTION CORP <br />4797684 <br />533348352 <br />DEMING CONSTRUCTION INC <br />2482656 <br />1295138816 <br />AME CONSTRUCTION CORP <br />6808725 <br />1713602560 <br />ENVISION GLASS INC <br />3300101 <br />803045376 <br />FRIEDGES DRYWALL INC <br />6956154 <br />1706131456 <br />INTERIOR COMPONENTS GROUP INC <br />7831788 <br />830095360 <br />SUNRISE SPECIALTY CONTRACTING INC <br />5911427 <br />801783808 <br />P L MARSH INTERIOR CONSTRUCTION INC <br />9194954 <br />1517568000 <br />SUPERIOR TILE & TERRAZZO INC <br />2224221 <br />1697792000 <br />CENTENNIAL FLOORING INC <br />8280826 <br />1589395456 <br />SWAY CONTRACTING INC <br />3157196 <br />24788992 <br />LOCKER DOCTOR LLC <br />6883830 <br />816201728 <br />AFFORDABLE BLIND COMPANY <br />3083523 <br />501055488 <br />SUMMIT FIRE PROTECTION CO <br />4083496 <br />311771136 <br />LAKES MECHANICAL SERVICES INC <br />2632762 <br />1033650176 <br />RAPID ELECTRIC LLC <br />1241786 <br />2049589248 <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) 600-657-3594, or (email) <br />Wthholding.tax@siate.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. <br />How to View and Print this Request <br />You can see copies of your requests by going to the History Tab, or by clicking the link below. To Print or email a copy of this <br />confirmation page, click one of the buttons below. <br />Click here to go to the History Tab <br />wj <br />P' terFriendl <br />Page 1 of 2 <br />https://www.mndor.state.mn.us/tp/eservices/—/ 5/8/2015 <br />