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Page 1 of 1 <br />rnDEPARTMENT <br />OF REVENUE <br />Contractor Affidavit Submitted <br />Thank you, your Contractor Affidavit has been approved. <br />Confirmation Summary <br />Confirmation Number: 0-537-286-080 <br />Submitted Date and Time: 5-Dec-2018 12:40:44 PM <br />Legal Name: NORTH VALLEY INC <br />Federal Employer ID: 41-1906523 <br />User Who Submitted: northva <br />Type of Request Submitted: Contractor Affidavit <br />Affidavit Summary <br />Affidavit Number: 633741312 <br />Minnesota ID: 3744649 <br />Project Owner: CITY OF RAMSEY <br />Project Number: 17-01 <br />Project Begin Date: 31-Jul-2017 <br />Project End Date: 14-Sep-2017 <br />Project Location: ALPINE DRIVE-RAMSEY <br />Project Amount: $348,074.53 <br />Subcontractor Summary <br />Name ID Affidavit Number <br />BURSCHVILLE CONST INC 6887256 1832280064 <br />ZAK INDUSTRIES INC 9254906 1371938816 <br />FRENCH LAKE CURB CO 3825384 546332672 <br />SAFETY SIGNS LLC 5139558 1730486272 <br />ALLSTATES PAVEMENT RECYCLING & STABILIZATION INC 3908651 260104192 <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 (email) <br />withholding.tax@state.mn.us. Business hours are 8:00 a.m. - 4:30 p.m. Monday - Friday. <br />Please print this page for your records using the print or save functionality built into your browser. <br />https://www.mndor.state.mn.us/tp/eservices/ /Retrieve/0/c-/bwfvgLOKNrrjk6BoLTgDfg_... 12/5/2018 <br />