State of Wisconsin Wis. Statutes s.16.75 DOA-3070 (R08/2003) BIDS MUST BE SEALED AND ADDRESSED TO: AGENCY ADDRESS: DEPARTMENT OF REGULATION & LICENSING 1400 E. WASHINGTON AVE RM. 175 MADISON, WI 53703 PO BOX 8935 MADISON, WI 53708-8935 REQUEST FOR BID #DRL11B01 Remove from bidder list for this commodity/service. (Return this page only.) Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid # _ . Late bids will be rejected. Bids MUST be date and time stamped by the soliciting purchasing office on or before the date and time that the bid is due. Bids dated and time stamped in another office will be rejected. Receipt of a bid by the mail system does not constitute receipt of a bid by the purchasing office. Any bid which is inadvertently opened as a result of not being properly and clearly marked is subject to rejection. Bids must be submitted separately, i.e., not included with sample packages or other bids. Bid openings are public unless otherwise specified. Records will be available for public inspection after issuance of the notice of intent to award or the award of the contract. Bidder should contact person named below for an appointment to view the bid record. Bids shall be firm for acceptance for sixty (60) days from date of bid opening, unless otherwise noted. The attached terms and conditions apply to any subsequent award. Bids MUST be in this office no later than THIS IS NOT AN ORDER BIDDER (Name and Address) NOVEMBER 12, 2010, 2:00 PM CT Name (Contact for further information) Jennifer West ([email protected]) Phone Date 608-267-3813 10/29/10 Quote Price and Delivery FOB Wisconsin Destination Fax bids are accepted Item No. Quantity and Unit Fax bids are not accepted Price Per Unit Total Description Payment Terms Delivery Time We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be certified by the Wisconsin Department of Commerce. If you have questions concerning the certification process, contact the Wisconsin Department of Commerce, 5th Floor, 201 W. Washington Ave., Madison, Wisconsin 53702, (608) 267-9550. Does Not Apply to Printing Bids. We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605. Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States. Yes No Unknown In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder, competitor or potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or competitor; that the above statement is accurate under penalty of perjury. We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid. Name of Authorized Company Representative (Type or Print) Title Signature of Above Date Phone ( Fax ( Federal Employer Identification No. ) ) Social Security No. if Sole Proprietor (Voluntary) This form can be made available in accessible formats upon request to qualified individuals with disabilities.
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