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617/23. 11:12 AM mndor.state.mn.us/tp/eservices/ /Retrieve/l)1Dc/UMcLLT1B86zWvzMKVvk5Sw ?FILE= Print2&PARAMS_ 25717116526701... <br />EP T E ool <br />T <br />M1 F REVENUE <br />Contractor Affidavit Submitted <br />Thank you, your Contractor Affidavit has been approved. <br />Confirmation Summary <br />Confirmation Number: <br />Submitted Date and Time: <br />Legal Name: <br />Federal Employer ID: <br />User Who Submitted: <br />Type of Request Submitted: <br />Affidavit Summary <br />Affidavit Number: <br />1507479652 <br />Minnesota ID: <br />6383131 <br />Project Owner: <br />CITY OF ELK RIVER <br />Project Number: <br />23-009 <br />Project Begin Date: <br />01-May-2022 <br />Project End Date: <br />12-May-2022 <br />Project Location: <br />ELK RIVER MN <br />Project Amount: <br />$60,640.00 <br />Subcontractors: <br />No Subcontractors <br />1-516-126-816 <br />7-Jun-2023 11:12:32 AM <br />EBI DRILLING SERVICES INC <br />84-2248516 <br />E BlDrillingservice sinc <br />Contractor Affidavit <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 Monday through Friday 8:00 a.m. to 4.30 p.m. Central Time. <br />Please print this p_ge for your records using the print or save functionality built into your browser. <br />hfinc•lhuw,u mn, —tofa mn ,tcltnloconriroc! Mel I TiRRR7W­h4S(%/vkriCu+ 9FII F =PrinOAPAPAMR=7571III RF7R7niQ7d7A ill <br />Page 71 of 201 <br />