Proposal 3130

CONTACT INFORMATION FOR RFP RESPONSE

Please provide the requested information for the individual(s) responsible for preparing your organization’s response to this RFP and/or to whom requests for additional information or clarification should be directed:

Name:

Title:

Address:

City/State/Zip:

Phone Number:

Fax Number:

Email:

ACKNOWLEDGMENT AND SIGNATURE

The undersigned, having carefully examined all sections and attachments to this Request for Proposal (RFP), does hereby offer to furnish all labor, materials, equipment, supplies, insurance and bonds specified, and all services necessary to fulfill the requirements set forth in the RFP. The undersigned further represents and warrants by its signature below that it has fully reviewed and understands all elements of the RFP, that all information submitted by it or included with its proposal, including all responses on this Submittal Form, is truthful and accurate, and that it agrees to be bound by all terms and conditions set forth in the RFP and its attachments. STATEMENT OF NON-COLLUSION The undersigned also certifies that this proposal is made without previous understanding, agreement or connection with any person, firm, or corporation making a proposal on this same service and is in all respects, fair and without collusion or fraud.

Company Name:

Signature of Representative: Printed Name of Representative:

Title:

Date:

(must be signed by a duly authorized officer or agent of the responding company)

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