Invitation to Bid 872. Instructional Equipment-Ultrasonic Flaw Detector

Similar documents
One Technology Court, Montgomery, AL Telephone:

One Technology Court, Montgomery, AL Telephone: Bid Invitation 841 Paint Booth Disassembly

Calhoun Community College will receive sealed bids for the following item(s): Bid #19-14: Iron Worker and Band Saw Machine

Invitation to Bid 889 AIDT EMPACT PROJECT MOVIE EQUIPMENT

ATTENTION ALL BIDDERS

ATTENTION ALL BIDDERS

ENTERPRISE STATE COMMUNITY COLLEGE

ATTENTION ALL BIDDERS

ATTENTION ALL BIDDERS

This is NOT AN ORDER, it is an invitation for a competitive sealed proposal.

Date Issued: February 7, 2018 Invitation To Bid No.:

LEGAL NOTICE REQUEST FOR BID SEALED BID For. Reinforcing Steel for Freymuth Road Box Culvert. For

INVITATION TO BID. FURNISHING AND DELIVERING GASOLINE AND DIESEL FUEL Requisition No. PW

INVITATION TO BID. 3. All bids submitted will be considered firm for a period of 60 days from the bid opening date.

TERMS AND CONDITIONS OF THE INVITATION TO BID

BIDDER MUST ATTEND MEETING IN ORDER FOR BID TO BE CONSIDERED

RFP # OFFICE SUPPLIES PROPOSAL OPENING DATE: July 16, 2015

PENN CAMBRIA SCHOOL DISTRICT 201 6th Street, Cresson, Pennsylvania DIESEL FUEL BID. Instructions/Specifications/Bid Form

COUNTY OF OSWEGO PURCHASING DEPARTMENT

REQUEST FOR PROPOSAL Police Department Roof System Renovation

Carpet Replacement Project Des Peres Department of Public Safety

ARLINGTON HEIGHTS PARK DISTRICT INVITATION FOR QUOTES

LEMONT BROMBEREK COMBINED SCHOOL DISTRICT 113A

CITY OF HOPKINSVILLE

SECTION A - INSTRUCTIONS

REQUISITION & PROPOSAL

REQUEST FOR PROPOSAL Enterprise Asset Management System

FLORIDA KEYS MOSQUITO CONTROL DISTRICT 5224 COLLEGE ROAD STOCK ISLAND, KEY WEST, FLORIDA RFP JET A FUEL

BETHLEHEM AREA SCHOOL DISTRICT 1516 SYCAMORE STREET BETHLEHEM PA REQUEST FOR BIDS TIRES & SERVICE School Year BIDS DUE: JUNE 4, 2018

Website: INVITATION TO BID Excavator

REQUISITION & PROPOSAL

REINFORCED CONCRETE PIPE ROUND (CLASS III & IV) ELLIPTICAL (CLASS III & IV)

QUOTE DOCUMENTS FOR CALLANAN GYM FLOOR REPLACEMENT center Street. Des Moines, Iowa QUOTE # Q7088

REQUEST FOR QUOTATION For Muster Room Classroom Tables for the Chatham County Detention Center

INSTRUCTIONS TO BIDDERS REQUEST FOR QUALIFICATIONS AND PROPOSAL THE BOROUGH OF LAVALLETTE, COUNTY OF OCEAN, NEW JERSEY 2019 CALENDAR YEAR

INVITATION TO QUOTE. Line item bid entries are to be entered on-line as directed (same due date) in the you received with these documents.

ATTENTION ALL BIDDERS

QUOTE DOCUMENTS FOR KING PARKING EXPANSION Forest Avenue. Des Moines, Iowa QUOTE # Q6747. Owner

CITY OF FREEPORT Water & Sewer Commission GIS DATA COLLECTION EQUIPMENT 524 W. STEPHENSON STREET FREEPORT, IL BID DOCUMENTS MARCH 2012

TOWN OF QUEENSBURY PURCHASE OF A NEW KIOTI TRACTOR FOR USE BY THE QUEENSBURY CEMETERY DEPARTMENT BID DOCUMENTS

REQUISITION & PROPOSAL

INVITATION FOR BID Annual Water Meter Purchase

FLORIDA DEPARTMENT OF LAW ENFORCEMENT

City of Rialto Purchasing Division Purchasing Manager: William Jernigan Phone: (909) Fax: (909)

ITB-CD Re-Bid Term Contract for Code Enforcement Mowing and General Clean Up Services. Required Submittal Packet. Revised per Addendum 2

TOWN OF MANCHESTER GENERAL SERVICES DEPARTMENT 494 MAIN STREET - P.O. BOX 191 MANCHESTER, CONNECTICUT

CONTRACT DOCUMENTS AND SPECIFICATIONS STREET SWEEPING

RFP FLORIDA KEYS MOSQUITO CONTROL DISTRICT REQUEST FOR PROPOSALS

LEGAL NOTICE - RFP WANTED. Automated Refuse Container Lids, For 300 Gallon Capacity Containers GENERAL INFORMATION AND INSTRUCTIONS

PRECAST CONCRETE BOX CULVERT FOR DAYTON CULVERT No. 11

ISLANDER LANDING GEAR OVERHAUL

Request for Proposal. INDEPENDENT CONTRACTOR ATTORNEY ACE CODE ENFORCEMENT Ref #121817RFPSOL LUZERNE COUNTY PENNSYLVANIA

Request for Quote (RFQ)

Furnish Traffic Safety Cones as specified below to be F.O.B. delivered to the locations listed, on or prior to the delivery date specified.

KEN BASS DIRECTOR OF PURCHASING Phone: NORTH 5 TH STREET Fax: NOTICE TO BIDDERS

* BID FORM. RIO BRAVO-GREELY UNION SCHOOL DISTRICT, acting by and through its Governing Board, herein called DISTRICT.

ROCK SALT FOR ICE CONTROL

RFQ-CD Re-Bid Wildfire Underbrush Mowing. Required Submittal Packet

BID RESPONSE LABEL THIS LABEL FOR USE WITH UNITED STATES POSTAL SERVICE DELIVERY RECONDITION MUFFIN MONSTER ELECTRIC (DATE): DEC.

Town of Templeton, Massachusetts Invitation for Bids Bulk Salt/Rock Salt

ITB-PW Concrete psi with Fiber Mesh. Required Submittals

REQUEST FOR PROPOSALS RFP SEASONAL ARTIFICIAL ICE SKATING RINK

ALABAMA A&M UNIVERSITY Carter and Chambers Fire Alarm System(s) A. Project Identification: New Fire Alarm system(s) Carter/Chambers

Office of the Director of Procurement Issued: Monday, October 23, Proposals Due by 12:00 NOON, EST on Wednesday, November 15, 2017 to:

State of Florida Department of Transportation. APRISA XE 960 MHz Radios

1911/1936 & Turner Creek Districts Sanitary Sewer I&I Abatement Project Phase 2

INSTRUCTIONS TO BIDDERS REQUEST FOR QUALIFICATIONS AND PROPOSAL THE BOROUGH OF LAVALLETTE, COUNTY OF OCEAN, NEW JERSEY BOROUGH AUDITOR

SPECIFICATIONS. Autoclave/Sterilizer FOR. Lake Land College District Number 517 Mattoon, Illinois PROJECT NO Bid Date; May 22, 2018

CITY OF FAIRBANKS BID REQUEST FOR FURNISHING LED STREET LIGHT FIXTURES (MATERIALS ONLY) THE CITY OF FAIRBANKS PUBLIC WORKS DEPT BID NUMBER: FB-14-41

Request for Bids (RFB) Fire Extinguisher Services (Service/Price Agreement)

LED Lighting. 3.3 Bidder shall furnish the required information typed or written in ink.

REQUEST FOR PROPOSALS For the Installation and Maintenance of a Backup and Disaster Recovery System

OSWEGO COUNTY PURCHASING DEPARTMENT. Purchasing Director Purchasing Clerk Purchasing Clerk

SECTION ADVERTISEMENT FOR BIDS

FLORENCE COUNTY SOUTH CAROLINA INVITATION-TO-BID NO /13 DESKTOP LIVE SCAN PLUS SYSTEM FLORENCE COUNTY SHERIFFS OFFICE

DATE: June 7,

COUNTY OF LOUISA, VIRGINIA

CITY OF WHITE HOUSE REQUEST FOR BID FOR PORTLAND ROAD LIFT STATION DRY PIT SUBMERSIBLE PUMP. August 22, 2017

REQUEST FOR BID 3D PRINTER FOR ILLINOIS VALLEY COMMUNITY COLLEGE BID # BID2017-B02

The PTC reserves the right to reject any or all bids. PTC may terminate any resulting contract upon a thirty (30) day written notice.

Lower Rio Grande Valley Development Council. Invitation to Bid (ITB): Tools and Maintenance Shop Equipment. office.

SPECIFICATIONS. Renovations and Additions to the Coffee Springs Senior Center. Coffee Springs, Alabama. CDBG Project No.

CITY OF WHITE HOUSE REQUEST FOR SEALED BIDS FOR HESTER DRIVE AND MILLING CONTRACT

REQUISITION & PROPOSAL

State of Florida Department of Transportation

INVITATION TO BID. City of Fort Oglethorpe POLICE DEPARTMENT 900 City Hall Drive Fort Oglethorpe, Georgia Phone: Fax:

5 REQUEST FOR QUOTATION. Company Name: Address: Contact Name: Contact Title: Phone Number: REQUEST FOR QUOTATION THIS IS NOT AN ORDER

INVITATION TO BID (ITB) FOR FOOD PRODUCTS ISSUE DATE: NOVEMBER 2, 2018 DUE DATE: NOVEMBER 30, 2018

LINCOLN UNIFIED SCHOOL DISTRICT CHROMEBOOK BID

Sunnyside Valley Irrigation District

INVITATION TO BID FOR AIR FILTERS ITB NO: DMS-15/ THE STATE OF FLORIDA DEPARTMENT OF MANAGEMENT SERVICES

REQUISITION & PROPOSAL

BID INVITATION. Contract Negotiation

Invitation for Bid Caustic Soda 50% T. F. Green Airport, Warwick, RI

BID INVITATION. Bid Invitation

INVITATION TO BID ISSUE DATE: Nov. 16, 2017 BID REQUESTED:

Meter Connect Supplies

County of Collier CLERK OF THE CIRCUIT COURT COLLIER COUNTY COURTHOUSE

BULLOCH COUNTY BOARD OF COMMISSIONERS 115 NORTH MAIN STREET STATESBORO, GEORGIA INVITATION FOR BID

INVITATION TO BID ISSUE DATE: July 28, 2017

Transcription:

One Technology Court, Montgomery, Alabama 36116 Telephone: 334-242-4158 Ed Castile Director Don Carson Business Manager Invitation to Bid 872 Instructional Equipment-Ultrasonic Flaw Detector Bid Must Be Received Before: Date: August 26, 2010 Time: 4:00 PM Bid Opening: Date: August 27, 2010 Time: 10:00 AM Submit bid proposal to: AIDT Bid Number 872 Attention: Janet D-Goodwin One Technology Court Montgomery, AL 36116 Table of Contents GENERAL CONDITIONS AND INSTRUCTIONS TO BIDDERS... 2 NONRESIDENT BIDDER INFORMATION... 5 VENDOR CERTIFICATION BY ALABAMA DEPARTMENT OF REVENUE... 5 ACKNOWLEDGEMENT OF RECEIPT FORM REQUESTS FOR BID... 6 SPECIFICATIONS... 7 QUALIFICATION STATEMENT... 12 STATE BOARD POLICY DISCLOSURE STATEMENT... 13 VENDOR DISCLOSURE STATEMENT INFORMATION AND INSTRUCTIONS... 14 VENDOR DISCLOSURE STATEMENT... 15

GENERAL CONDITIONS AND INSTRUCTIONS TO BIDDERS 1. All bids shall be sealed when received (The Code of Alabama 1975, Section 41-16-54) Bids delivered by the vendor, United States Postal Service, Federal Express, UPS or other delivery service must be identified on front of the envelope in the lower left corner with the bid number, opening date and time indicated. It is the responsibility of the vendor to have the bid proposal delivered to the correct addressee and location. 2. Bids must be received prior to bid receive date and time indicated on the bid. Late bids or improperly submitted bid will not be considered. 3. All information shall be entered in ink, typewritten or computer generated in the appropriate space on the forms. An authorized company representative must sign bid in ink. 4. AIDT reserves the right to reject any or all bids, or any part thereof, and to waive any technicality in the bidding in the best interest of the Institute. Bids will be awarded in the best interest of AIDT. 5. This proposal is to be made without connections with any other person, company, or parties making a bid or proposal and is to be in all respects fair and in good faith, without collusion or fraud. 6. Bid prices are not to include tax. AIDT, a state government institution, is specifically exempted by law, from paying Alabama Sales Tax. This exemption is found in Section 40-23-4 (a) (11), Code of Alabama, and it further explained in the Sales & Use Tax Rule 810-6- 3-.69.02. 7. Quote is F.O.B. destination. Any freight charges must be included in the bid prices. The successful bidder must assume all liability/responsibility for damage in transit. 8. AIDT terms and conditions and the laws of the State of Alabama shall govern any contract resulting from this bid. 9. The responsibility of determining the acceptability of any products offered rests solely with AIDT. 10. Bidder shall, at its sole expense, procure and keep in effect all necessary permits and licenses required for its performance of the requested work or service. 11. It is the responsibility of the bidder to inspect the facilities (grounds, road access, and buildings) for delivery method, installation and/or set-up of materials, supplies and/or equipment. Failure to inspect the facilities will not relieve the bidder of responsibility to provide for delivery F.O.B. or additional costs associated with delivery, installation and set up as requested in the bid. 2

12. Bidders desiring further information or interpretation of plans or specifications must make requests in writing to AIDT, Attn.: Janet D-Goodwin, One Technology Court, Montgomery, Alabama 36116, or email jgoodwin@aidt.edu at least three (3) days prior to bid opening. Answers to such requests will be given to all recorded bidders, in addendum form, which will be included as part of the contract documents. 13. All bids must be notarized. 14. References in the specifications to name brands, catalog numbers, etc are for identification purposes only and in no way are intended to eliminate or discourage the offering of substitute items which exceed or equal the specifications. 15. When brand name or catalog number is not stated by the bidder, it is understood the offer exactly as specified. If bidding a substitute item bidder must provide specifications for the item (s) bidding. SPECIAL CONDITIONS AND INSTRUCTIONS TO BIDDERS 16. VENDOR RESPONSIBILITY: It is the responsibility of all bidding vendors to read this entire bid from beginning to end and to comply with all instructions, specifications and terms and conditions of the bid. 17. BID IDENTIFICATION: Reference Page 2, Item 1, Due to the Postal Service putting bar code labels on enveloped, it conceals the bid number and date if the vendor has written them other than the lower left corner, therefore the bid would be rejected for not being properly identified. 18. AWARD METHOD: Each item must be priced separately. However, an All or None Award will be made to the lowest responsible bidder meeting all specifications of the bid. 19. REQUESTED INFORMATION: Any additional information requested from a vendor must be furnished within (3) days from receipt of request. Failure to furnish information within time frame above will result in bid rejection. Requested documentations in Items 22-24 must be submitted with bid proposal. 3

20. NOTE TO VENDOR: Failure to submit documentations in Items 21-23 with bid proposal will result in bid rejection. 21. SUBMIT WITH BID PROPOSAL: All vendors must submit with their bid proposal a copy of their current state, county or city business license, general contractor s license or applicable license as required by law. 22. SUBMIT WITH BID PROPOSAL: All vendors will be required to complete and submit with their bid proposal a Disclosure Statement filled out in its entity as required by Act 2001-95. Act 2001-955 requires the disclosure statement to be completed and filed with all proposals, bids, contracts, or grant proposals to the State of Alabama in excess of $5,000. The Vendor Disclosure Statement is included in the bid proposal and can also be found on AIDT s website: http://aidt.edu/bids/index.html. 23. SUBMIT WITH BID PROPOSAL: All vendors must submit with their bid proposal a copy of their General Liability (umbrella) insurance, or the bid will be rejected. The coverage must be in effect for the contract period. The copy must show amount limits for automobile, workmen s compensation, etc. (applicable for the delivery of materials, supplies, etc.). Vendor is responsible for all losses/damages caused by its employees. ***********************IMPORTANT INFORMATION**************** For specification and procedural questions, contact AIDT Purchasing Agent: Janet Goodwin @ (334) 280-4415 or jgoodwin@aidt.edu. 4

NONRESIDENT BIDDER INFORMATION Act Number 2001-637 of the Alabama Legislature, and is codified as Code of Alabama, Section 39-3-5, provides as follows: 39-3-5. Preference to resident contractors in letting of certain public contracts required; reciprocity. (a) In the letting of public contracts in which any state, county or municipal funds are utilized, except those contracts funded in whole or in part with funds received from federal agency, preference shall be given to resident contractors, and a nonresident bidder domiciled in a state having laws granting preference to local contractors shall be awarded Alabama public contracts only on the same basis as the nonresident bidder s state awards contracts to Alabama contractors bidding under similar circumstances; and resident contractors in Alabama, as defined in Section 39-2-12, be they corporate, individuals, or partnerships, are to be granted preference over nonresidents in awarding of contracts in the same manner and to the same extent as provided by the laws of the state domicile of the nonresident. (b) Nonresident bidders must accompany any written bid documents with a written opinion of an attorney at law licensed to practice law in such nonresident bidders state of domicile, as to the preferences, if any or none, granted by the law of that state to its own business entities whose principal places of business are in that state in the letting of any or all public contracts. (c) A summary of this law shall be made a part of the advertised specifications of all projects affected by this law. (Acts 1984, No. 84-228, p.348.) VENDOR CERTIFICATION BY ALABAMA DEPARTMENT OF REVENUE Certification Pursuant to Act Number 2006-557 Alabama Law (Section 41-4-116, Code of Alabama 1975) provides that every bid submitted and contract executed shall contain a certification that the vendor, contractor, and all of its affiliates that make sales for delivery into Alabama or leases for use in Alabama are registered, collecting, and remitting Alabama State and Local sales, use, and/or lease tax on all taxable sales and leases into Alabama. By submitting this bid, the bidder is hereby certifying that they are in full compliance with Act Number 2006-557, they are not barred from bidding or entering into a contract pursuant to 41-4-116, and acknowledges that the awarding authority may declare the contract void if the certification in false. 5

ACKNOWLEDGEMENT OF RECEIPT FORM REQUESTS FOR BID In acknowledgement of receipt of the Request for Bid, the undersigned agrees that he/she has received a complete copy, beginning with the title page and table of contents and ending with the second page of the Disclosure Statement. The acknowledgement of receipt should be signed and returned by the vendor no later that the close of business on August 20, 2010. Only potential vendors who elect to return this form completed with the indicated intention of submitting a bid will receive copies of all offers or written questions and written responses to those questions as well as RFB amendments and or addendums, if any are issued. Firm Represented by Title Email Phone Number Fax Number Address City State Zip Signature Date Firm does does not (circle one) intend to respond to this Request for Bid. The following name and address must be used for all correspondence related to the Request for Bid: AIDT ITB 872 Attention: Janet D-Goodwin One Technology Court Montgomery, Alabama 36116 Form may be faxed to 334-613-9309 Or Emailed to jgoodwin@aidt.edu Attention: Janet D-Goodwin 6

SPECIFICATIONS Bid 872 Instructional Equipment, Ultrasonic Flaw Detector LINE NO. DESCRIPTION QTY/ UOM UNIT PRICE EXTENDED PRICE 00001 EPOCH 1000i Portable Digital Ultrasonic Flaw Detector with Phased Array, BNC Connector, USA Powercord, English Keypad, English Manual, Large Transport Case. Olympus, P/N: EP 1000I-B-UEE-L 00002 Standard Phased Array Probe, 5 MHz Linear Array, 16 Elements, 9.6x10 mm Total Active Aperture, 0.60 mm Pitch, 10 mm Elevation, A10P Case Type, Impedance Matching to Rexolite, PVC Sheathing, 2.5 m Cable Length, Omniscan Connector Olympus, P/N: 5L16-9.6X 10-A1 0P- P-2.5-OM 00003 Manual wedge for angle beam phased-array probe A10P, normal scan, 55-degree shear wave, plain wedge (without irrigation holes and carbides). Olympus, P/N: S A 1 0P - N55S 00004 Manual wedge for angle beam phased-array probe A10P, normal scan, 0-degree longitudinal wave, plain wedge (without irrigation, holes, carbides). Olympus, P/N: SA10P-0L 00005 Angle Beam Transducer, 2.25 MHz, 0.50" Element Diameter, Miniature Screw-In Case Style, Straight Microdot Connector Includes Test Form Certificate Olympus, P/N: A540S-SM Page Total $ Company Name FEIN Date _ 7

LINE NO. DESCRIPTION QTY/ UOM UNIT PRICE EXTENDED PRICE 00006 Angle Beam Transducer, 5 MHz, 0.50" Element Diameter, Miniature Screw-In Case Style, Straight Microdot Connector Includes Test Form Certificate Olympus, P/N: A541S-SM 00007 Wedge, Accupath, for use with 0.50" Element Trandsucers, 45 degrees Olympus, P/N: ABWM-5T-45 00008 Wedge, Accupath, for use with 0.50" Element Trandsucers, 60 degrees Olympus, P/N: ABWM-5T-60 00009 Wedge, Accupath, for use with 0.50" Element Trandsucers, 70 degrees Olympus, P/N: ABWM-5T -70 00010 Cable. Standard & BNC to MICRODOT. 4'. RG-174 Olympus, P/N: BCM-74-4 00011 Dual Transducer, 5 MHz, 0.434" Tip Diameter, Straight Microdot Connector, Includes EN121668 Certificate. Olympus, P/N: D790-SM 00012 Cable for D790-SM, D797-SM, D798-SM or D7906-SM - Dual BNC to MICRODOT, 5 Feet OHM Olympus, P/N: BCMD-3 1 6-5B Page Total $ Company Name FEIN Date _ 8

LINE NO. DESCRIPTION QTY/ UOM UNIT PRICE EXTENDED PRICE 00013 Couplant. Propylene Glycol &2 oz. Squeeze Bottle (.06 liters) Olympus, P/N: A2 00014 Couplant. Gel Type (SOUND SAFE) &12 oz. Squeeze Bottle (.35 liters) Olympus, P/N: D12 $ $ 00015 Test Block. 4-Step. 1018 Carbon Steel. English Unit.25"..50"..75". 1.00" Precision Thickness Olympus, P/N: 2212E $ $ 00016 ASTM E164 IIW Type Block in 1018 STEEL (without F129 case) Olympus, P/N: TB7541-1 00017 ASTM E164 IIW Type Block in 7075 ALUMINUM (without F129 case) Olympus, P/N: TB7541-4 00018 Finished hardwood case for TB5939-X 4 EA $ $ Olympus, P/N: F129 00019 Gageviewpro Software for the Epoch; includes EP4/C- USB-6 1 EA $ $ Olympus, P/N: GAGEVIE W P R O - KIT-USB Page Total $ Company FEIN Date 9

LINE NO. DESCRIPTION QTY/ UOM UNIT PRICE EXTENDED PRICE 00020 EPOCH XT and EPOCH 1000 Series VGA Output cable. 6 feet. 1 EA $ $ Olympus, P/N: EPXT-C- VGA-6 00021 Contact Transducer, 5 MHz, 0.50" Element Diameter, Fingertip Case Style, Right Microdot Connector Olympus, P/N: M109-RM 00022 Contact Transducer, 2.25 MHz, 0.50" Element Diameter, Fingertip Case Style, Right Microdot Connector Olympus, P/N: M106-RM Page Total $ Bid Total $ EQUIPMENT WARRANTY: years months NOTE TO BIDDERS: Read the entire bid document from beginning to end and comply with all instructions, specifications and terms and conditions of the bid. Failure to follow all instructions and terms conditions will result in the rejection of your bid. This is an ALL or NONE bid for Olympus brand products only that will be used for instructional purposes. *ALL bidders must be able to supply all the items listed in the bid specifications. Bidders must comply with all Bid Instructions on pages 2-4, to include Item 7 - Freight Charge FOB Destination on page 2. Failure to submit requested documentations on Page 4 in Items 21-23 with bid proposal will result in bid rejection. Company FEIN Date 10

TRAINING: Vendor must provide ten (10) hours of on-site Epoch 1 000i instrument orientation to be performed by sales representative.* DELIVERY HOURS: 7:00 am - 3:00 pm Monday through Thursday and 7:00 am 12:00 pm Friday, except on holidays Deliver To: AIDT Montgomery Center Attention: Chris Burge or Project Support Address: One Technology Court Montgomery, AL 36116 Offer to AIDT, Montgomery, Alabama; I certify that I have read all the General Conditions and Instructions to Bidders of this bid and this offer is made without prior understanding, or connection with any entity or person submitting a bid for the same materials, supplies or equipment, and is in all respects fair and without collusion or fraud. I am authorized to sign this bid for the bidder. I agree to abide by all conditions of this bid request. Company Name FEIN Date Address: City State Zip Phone Fax Email Person submitting bid typed/printed name Signature Job Title Remit to address if difference from above: City State Zip Contact Job Title 11

QUALIFICATION STATEMENT I certify that I have read all the General Conditions and Instructions to Bidders of this bid and this offer is made without prior understanding, or connection with any entity or person submitting a bid for the same materials, supplies or equipment, and is in all respects fair and without collusion or fraud. I am authorized to sign this bid for the bidder. I agree to abide by all conditions of this bid request. Name of Company (please type or print in ink) Complete Address for Mailing Purchase Order and Payment Authorized Signature (sign in ink) Typed/Printed Name of Signature Above City State Zip Code Title (please type) Telephone Number Fax Number NOTARIZATION Sworn and subscribed before me this the day of, Notary Public Signature My commission expires (date) MINORITY INFORMATION If this business is minority owned please qualify status below: 12