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Proposer: _GRANTS SERVICE LLC <br />ITRE <br />4/912014 <br />1.3 - CONTRACTOR INFORMATION SHEET <br />Request for Verification 1 Notification of Information Changes <br />Name of Business <br />or Individual: <br />Owner's Name: <br />GRANTS SERVICE LLC <br />(List name as will appear on Invoice) <br />GRANTS SERVICE LLC <br />(Individuals: names as it appears on Social Security Card <br />Sole Proprietorships: Name as it appears on SS Card or EIN Notification as used below <br />Partnerships and Corporations Correct legal name of business) <br />Primary Contact: Angela J. Grant <br />Secondary Contact: David P. Grant <br />Mailing Address: P. O. Sox 791 <br />Jamestown, NC 27282 <br />Physical Address: 4122 Quarterstaff Ct. <br />High Point, NC 27265 <br />Taxing County: Guilford <br />(if NC) <br />Business & individual Characteristics (Complete All): Number of Years: <br />Check ALL That Apply_ ❑ NCDOT Certified DBE At this location _14+ yrs <br />0 Individual* F1 Minority-Owned Bus (MBE) Under current ownership /management: _4 +_ yrs <br />❑ Sole Proprietorship" Women -Owned Business p <br />❑ Federal Government Enterprise (WBE) (W(Y, ,54ose4 <br />State Government <br />❑ Local Government <br />q Partnership ** <br />❑ Corporation (Check ALL that apply) ** <br />❑ Not For Profit <br />❑ Sub - Chapter S * can be either Social Security Number or Federal EIN <br />❑ Medical 1 Health — Partnerships & Corporations must furnish Federal EIN <br />This information is true and accurate to the best of my knowledge and ability. <br />Typed Name of Person Completing this Form: Angela J. Grant <br />Title: Owner /President <br />Signature: L Date April 9, 2014 <br />ITRE i 2 4/9/2014 <br />Attachment number 2 <br />Work Phone #: <br />Cell Phone #: <br />Fax #: <br />Email Address: <br />Work Phone #: <br />Cell Phone #: <br />( 336) 812 -8162 <br />( 336) 803 -0364 <br />( 336) 812 -8062 <br />GSC @northstate.net <br />( 336 ) 803 -0364 <br />Number Used To File Federal Income Tax: <br />Federal Tax ID: 27-2504064 <br />MUST BE CORRECT FOR 1099 PURPOSES <br />DUNS # (ARRA) NIA <br />F -5 Page 211 <br />