![](data:image/svg+xml;base64,PD94bWwgdmVyc2lvbj0iMS4wIiBlbmNvZGluZz0iVVRGLTgiPz4KPHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHhtbG5zOnhsaW5rPSJodHRwOi8vd3d3LnczLm9yZy8xOTk5L3hsaW5rIiB3aWR0aD0iMTQ4Ny41cHQiIGhlaWdodD0iMTkyNXB0IiB2aWV3Qm94PSIwIDAgMTQ4Ny41IDE5MjUiIHZlcnNpb249IjEuMiI+CjxnIGlkPSJzdXJmYWNlMzMiPgo8L2c+Cjwvc3ZnPgo=)
other business in which the applicant has or has ever
had an interest.
(2) The legal business name, any assumed business name,
designated business address, physical address, telephone
number and email address of the applicant.
(3) For an out-of-State business entity, the legal
business name, any assumed business name, designated business
address, physical address, telephone number and email address
of the applicant and any identification number issued to the
applicant by the applicant's state or political subdivision
through registration, licensing or verification systems, if
applicable.
(4) For any individual, sole proprietor, primary owner
or officer, including a chief executive officer, chief
financial officer, chief operating officer or an equivalent
officer, of a business entity, the name of all other persons
with an ownership interest in the applicant that are not
identified under paragraph (1). This paragraph does not apply
to shareholders with less than a 5% ownership interest in a
publicly traded corporation.
(5) A description of the nature of the business of the
applicant.
(6) Whether the applicant has been suspended or debarred
within the last 10 years.
(7) Proof of financial responsibility, which may include
liability insurance or bonding, or self-insurance.
(8) The fee specified under section 10.
(9) A signed statement by the applicant that the
information in the application is true and accurate and any
individual signing the application is an authorized agent of
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