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NEW PUBLIC WORKS DIVISION 402 WEST WASHINGTON STREET ROOM W467 INDIANAPOLIS INDIANA 46204-2746 CERTIFICATION BOARD INDIANA DEPARTMENT OF ADMINISTRATION APPLICATION FOR PREQUALIFICATION CERTIFICATE FOR CONTRACTORS SUBCONTRACTORS AND JOINT VENTURES PERSON SUBMITTING FIRM NAME STREET ADDRESS MAILING ADDRESS CITYSTATEZIP CODE AREA CODE PHONE NUMBER FAX NUMBER DATE SUBMITTED FEDERAL I. D. NUMBER STATE FORM 35153 REV. 9/04 Certification with the State ...
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