HomeMy WebLinkAbout2003 - ContractY=0001
YOUNG'S COMMUNICATIONS CO., INC.
Municipal Airport
Trenchless Conduit Installation
Copy
October 27, 2003
BID PROPOSAL PRICE FORM
,t.%� The undersigned having become thoroughly familiar with all of the Bidding Documenis incorporated herein, the work site
locations and conditions, and time schedule affecting the work, hereby proposes to perform everything required to be
performed in strict conformity with the requirements of these documents, and to furnish all the supervision, labor,
equipment, tools and materials necessary to perform the installation of fiber optic cable meeting or exceeding the
specifications and special conditions as set forth herein for the prices quoted below. The prices quoted are inclusive of any
Addenda that may be issued.
By the signature below, the Contractor agrees that this Bid is made without any other understanding, agreement, or
connection with any person, corporation; or firm submitting a bid for the same purpose and that the bid is in all respecLs
fair- and without collusion or fraud. If awarded this bid, the Contractor agrees to enter into said agreement within ten (10)
consecutive calendar days notice by the City, and agrees to all the terms and conditions of all documents stated herein with
the City of Sebastian for the below stipulated prices which shall remain firm for sixty (60) days following bid opening date.
TRENCHLESS INSTALLATION OF CONDUIT
DESCRIPTION
QUANTITY
UNIT
UNIT PRICE
ITEM TOTAL
Furnish and install 4" pvc conduit crossing under a taxiway
I Location
Each
52178.00
S 2178.00
Furnish and install 4" pvc conduit crossing under roads
4 Locations
Each
S
664.20
S
2656.80
Furnish and install 4" pvc conduit crossing under canal
1 Location
Each
S1364.00
S 1364.00
GRAND TOTAL AMOUNTS 6198.80
NOTES:
• The Quantities indicated on this Bid are estimates of the Cit ,, s requirements and shall only be, used for the purpose of
Bid Evaluation and Award. The Bid Quantities do not constitute a guarantee of work. The Vendor agrees that that the
prices quoted have taken in consideration that the Actual Quantities may exceed or may be lower than the Quantities
indicated on this Bid.
The CA37 reserves the right to make the award to the Bidder submitting the lowest GRAND TOTAL AMOUNT
pro -tiding the Bidder is moth responsible and responsive. The City hereby reserves the right to reject any bid if it has
doubts about the Bidder's prior experience, ability, capacity, skill., reputation, reliability, and/or any other factor(s)
which may lead to doubt reasonable performance.
• CONTRACTOR WARRANTS TOTAL TIME TO COMPLETE ALL THE WORK SHALL NOT EXCEED 20 C0NsECTrrJVE
CALENDAR DAYS.
444 Aga/tn_ C//-/P 9P,4SW -eh-2
Authorized Siganiare Printed Name
Finn Name & Addres.
YOUNG'S COMMUNICATIONS CO,, INC.
820 East Seminole Avenue
Melbourne, FL 32901-4632
Tilk
3,2/- 7,2j -
Phone N=ber
Date Sued /O 3
Awft�
kV1 L! LV 1V. VV -
. 11. CERTIFICATE OF LIABILITY INSURANCE DATE E(MIAIDOI0
1a /1/3
PRDDLIGER. THIS CERTIFICATE IS 1SSUEb AS A MATTER OF INFORMATION
Brown & Brown, Inc.- Melbourne ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
6767 N. Wickham Rd Suite 100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Nfelliournl =, FL 32940 -2024
321.757 -8686'
WSUt7E0
Young's Communications Co., Inc.
820 E. Seminole Ave.
Melbourne, FL 32901 -4632
INSURERS AFFORDING COVERAGE
INSURER A: AIG-Ameri can Home _ _ - - -
wsyRERS: AIG- _Ameri can _int_ernat oval S_c -uth -
INSURERC: CrLIITI T &Forster -U S Fire - insurance
INSURER D.'
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO7WfTHSTANDWG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE M
MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCP JBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
fl P
P CCY EFFECTIVE
- (Per =Idw)
1
GARAGE LIABILITY AUTO ONLY • FA ACCIDENT S
I ANYAUTO _..r . —_ °- .�— ..._ -- --
OTHER THAN EAACC $ ....__..—
AUTO ONLY; AGG- $
C°
EXCESS UABILITY 553084822 08/01/03 08/01/04 E)ICHOCCLIRRENCE _ 52 000 000
X] OCCUR I _ I CLAIMS MADE AGGREGATE - SZ , O 0,,.0 0 a
i DEDUCTIBLE
S
I X RETENTION 510000- - -_ - -._
A WORKERS COMPENSATION AND 2283573 08/01/03 08/01/04
p
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $ 000, 0 0 0
E.L DISEASE _ EA EMPLOYEE $1 000,000
OTHER E.L. DISEASE - POLICYItMIT $1,000, 0aa
DESCRIPTION OFOPERATIONSJLOCAT IONSryEHICLESrFXCLUS*NS ADDED BY E.NDORSEMEMISPECIAL PAOVMONS
Fax 772- 589 -2566
IREO.WSURERLETIER:
City of Sebastian
Construction Board
1225 Main Street
Sebastian, FL 32958
ACORN 25•S (719T) 1 of 2 #104542
SHOULD ANYOF THE ABOVE DESCRIBEO POLPCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TOMAIL I- 0._DAYSWRITTEN '
NOTICE TOTHE CERTIFICATE HOLD ERNAMED TO THE LEFT, BUT FAILURE TO DOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER,ITS AGENTS OR
DLD O ACORD CORPORATION 1988
DESCRIPTION OFOPERATIONSJLOCAT IONSryEHICLESrFXCLUS*NS ADDED BY E.NDORSEMEMISPECIAL PAOVMONS
Fax 772- 589 -2566
IREO.WSURERLETIER:
City of Sebastian
Construction Board
1225 Main Street
Sebastian, FL 32958
ACORN 25•S (719T) 1 of 2 #104542
SHOULD ANYOF THE ABOVE DESCRIBEO POLPCIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TOMAIL I- 0._DAYSWRITTEN '
NOTICE TOTHE CERTIFICATE HOLD ERNAMED TO THE LEFT, BUT FAILURE TO DOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITY OP ANY KIND UPON THE INSURER,ITS AGENTS OR
DLD O ACORD CORPORATION 1988
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD SEQ #L03071700478
LICENSE NBR
07/17/20031030034441 IQB0019840
- •-The BUSINESS ORGANIZATION
_lamed below IS QUALIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2005
(THIS IS NOT A LICENSE TO PERFORM WORK. THIS ALLOWS
COMPANY TO DO BUSINESS ONLY IF IT HAS A QUALIFIER.)
YOUNG'S COMMUNICATIONS CO INC
820 E SEMINOLE AVE FL 32901
MELBOURNE
JEB BUSH
GOVERNOR
AC# 0514345
DIANE CARR
DISPLAY AS REQUIRED BY LAW SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEQ #LO2DB0200796
CONSTRUCTION INDUSTRY LICENSING BOARD
The UNDERGROUND UTILITY & EXCAVATION CO
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2004
Aaml
YOUNG, STEVE ALAN
YOUNGS COMMUNICATIONS CO INC
3315 WESTLAND ROAD
MELBOURNE FL 32934
JEB BUSH RIM BINKLEY -SEYER
GOVERNOR DISPLAY AS REQUIRED BY LAW SECRETARY
2003-2004 BREVARD COUNTY
000159035
ROD NORTHCUT7. Tax Gollcxlo , E,aevarci CounCounty.
Titusville, r- Iorir }G 32780
OCCUPATIONAL LICENSE
SUBJECT TO COUNTY ZONING RESTRICTIONS
Accaunr NUMBER
EXPIRES SEPTEMBER 30, 2004
LICENSE PERIOD OCTOBER T, 2003 - SEPTEMBER 30, 3004
$SSUED PURAUANT
A14D SUBJECT TO FLORIDA STATUTES AIJD EREVARD COU14TY ORDINANCES. ISSUANCE DOLS fi -OT CERTif Y
LICENSE SHOULD BE DISPLAYED ON PREMISES
COMPLIANCE WITH ZONIN.^: OR OTHER LAWS THIS LICENSE MUST BE POSTED COIJSPdCUDUSIY Ilt PLACL OF BUSAILSS
STATUTE
DESCRIPTION AMOUNT
THE PERSON(S), OR ENTITY BELOW:
30255
EXCAVATING /
L.ANDCLEAR I NG
30755
UTILITY LINE
ELECT. CONTR.
YOUNG'S COMMUNICATIONS
82004
2003 - 2004 LICENSE AMT. T5. 25
CO INC
820 E SEMINOLE AV
MELBOURNE FL
2901
IS LICENSED AS INDICATED FOR
THE FOLLOWING LOCATION:
r;1 SEM I POLE AV E
OWNED BY:
YOUNG'S COMMUNICATIONS CO INC
CORPORATION (PRIVATE)
AMOUNT DUE ON THIS TRANSACTION: $
UPON ACHANGE OF OWNERSHIP OR LOCATION,
LICENSE SHOULD BE TRANSFERRED WITHIN 30 DAYS. NOTIFY TAX COLLECTOR UPON CLOSING OF BUSINESS.
3 5A. 2
�; r.
n T�3
1~i
O r-'
K
r I rz'
SEBASTrAN CONSTRUCTION BOARD
-. 1225 NWN STREET
SEBAASTIAN, FL 32958
(772) 388 --8245
LICENSE RENEWAL FORM 2003 - 2004
* ** *PLEASE CONQLETE IN FUEL* ***
* * *AN INICOMPLETE FORM OR MISSING REQUaUD PAPERWORK WILL
RESULT IN SA vT BEING RETURNED TO APPLICANT. * **
DATE 10/21/03
ACTNE X INACTIVE
APPLICANT'S FULL NAME Steve A. Young
SOCIAL SECURITY63 -93 -5913 DR,'S LIC #. Y52078163083 STFL
QUALTEYNG AS: SOLE PROPRIETOR () PARTNERSHIP {) CORPORATTONX�
NAMEOFFIRMORCOMPANYYoung's Communications Co., Inc.
BUSINESS
ADDRL-SS 820 E. Seminole Ave pH(DN-E 321- 723 -6025
C= Melbourne
MA LING ADDRESS same
CATEGORY OF LICENSE BEING
STATE FL
APPLICANT'S SIGNATURE v '- —
REQma�yy.. ���v�y-� x �y+�ryry Y+�'
V1_i E,D PA L, RTT
Zjp 32901 --4632
RHONE
1) CONTRA.CTORS4300,000 Liability, $1110,000 Property Damage;
SUB - CONTRACTORS -S 100,000 Liability, $50,000 Property Damage;
2) Workman's Comp. and/or Exemption as required by law,
3) Copy of current State Registration or Certification.
4) Copy of Current Occupational license where business is physically located.
* ** *SDI+ ATTACHE, M SCMDUL -E * ***
renewal.doc
DRUG -FREE WOR10'EAC:E FORM
The undersigned Contractor, in accordance with Florida Statute 287.087 hereby
certifies that Young's Communications does-
Publish a statement notifying employees that the unlawful .manufacture,
distribution, dispensing, possession, or use of a controlled substance is
prohibited in the workplace and specifying the actions that will be taken
against employees for violations of such prohibition.
2. inform employees about the dangers of drug abuse in the workplace, the
business' policy of maintaining a drug -free workplace, any available drug
counseling, rehabilitation, employee assistance programs and the penalties
that may be imposed upon employees for drug abuse violations.
3. Give each employee engaged in providing the commodities or contractual
services a copy of the statement specified in Paragraph l .
4. In the statement specified in Paragraph 1, notify the employees that, as a
condition of working on the commodities or contractual services that the
employee will abide by the terms of the statement and will notify the
employer of any conviction of or plea of guilty or nolo contendere to any
violation of Chapter 1893 or of any controlled substance law of the United
,0=14, States or any state, for a violation occurring in the workplace no later than
five (5) days after such conviction.
5. Impose a sanction on, or require the satisfactory participation in a drug
abuse assistance or rehabilitation program if such is available in the
employee's community, by any employee who is so convicted.
5. Make a good faith effort to continue to maintain a drug -free workplace
through irnplencmentation of Paragraph 1 through 5 _
As the person authorized to sign this statement, I certify that this firm complies
fully with the above requirements.
Date:_ ���a.3 4 ADZ
Contractor
Curtis L. Tlegs
Commission #DD 157354
Expin s Oct !o, 2oo6
Bonded Thru
.a
AWantg Bonding o., Inc.
SWORN STATEMENT UNDER SECTION 287.133(3)(a),
,,� FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC
OR OTHER OFFICER AUTHORIZE, D TO ADMINISTER OATHS.
1. This sworn statement is submitted with the Municipal Airport Installation
of Conduits Bid for THE CITY OF SEBASTIAN.
2. This sworn statement is submitted by Young's Communications., whose
business address is 820 E. Seminole Ave.Melb. 32901 and (if applicable) its
Federal Employer Identification (FEIN) is 59- 1398816
3. My name is Ck�s "�ti��' c3�.�sr�.� (please
print name of individual signing) and my relationship to the entity named above is
4. 1 understand that a "public entity crime" as defined in Paragraph
287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a
person with respect to and directly related to the transaction of business with any
public entity or with an agency or political subdivision of any other state or with
the United States, including, but not limited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision
of any other state or of the United States and involving antitrust, fraud, theft,
r•. bribery, collusion, racketeering, conspiracy, or material misrepresentation.
5. I understand that "convicted" or "conviction" as defined in Paragraph
287.133(l)(b), Florida Statutes, means a finding of guilt or a conviction of a
public entity crime, with or without an adjudication of guilt, in any federal or state
trial court of record relating to charges brought by indictment or information after
July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty
or nolo contendere.
6. I understand that an "affiliate" as defined in Paragraph 297.133(l)(a),
Florida Statutes, means:
(1) A predecessor or successor of a person convicted of a public entity crime,
or
(2) An entity under the control of any natural person who is active in the
management of the entity and who has been convicted of a public entity crime.
The term "affiliate" includes those officers, directors, executives, partners,
shareholders, employees, members, and agents who are active in the management
of an affiliate. The ownership by one person of shares constituting a controlling
interest in another person, or a pooling of equipment or income among persons
when not for fair market value under an arm's length agreement, shall be a prima
facie case that one person controls another person. A person who knowingly
enters into a joint venture with a person who has been convicted of a public entity
crime in Florida during the preceding 36 months shall be considered an affiliate.
7. I understand that a „person" as defined in Paragraph 287.133(1)(e), Florida
Statutes, means any natural person or entity organized under the laws of any state
or of the United States with the legal power to enter into a binding contract and
which bids or applies to bid on contracts for the provision of goods or services let
by a public entity, or which otherwise transacts or applies to transact business
with a public entity. The term "person" includes those officers, directors,
executives, partners, shareholders, employees, members, and agents who are
active in management of an entity.
S. Based on information and belief, the statement which I have marked
below is true in relation to the entity submitting this sworn statement. (Please
indicate which statement applies.)
Tom% Neither the entity submitting this sworn statement, nor any officers,
directors, executives, partners, shareholders, employees, members, or agents who
are active in management of the entity, nor any affiliate of the entity have been
charged with and convicted of a public entity crime subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more of the officers,
directors, executives, partners, shareholders, employees, members or agents who
are active in management of the entity, or an affiliate of the entity has been
charged with and convicted of a public entity crime subsequent to July 1, 1989,
AND (Please indicate which additional statement applies.)
There has been a proceeding concerning the conviction before a hearing
officer of the State of Florida, Division of Administrative Hearings. The
final order entered by the hearing officer did not place the person or affiliate on
the convicted vendor list. (Please attach a copy of the final order.)
The person or affiliate was placed on the convicted vendor list. There has
been a subsequent proceeding before a hearing officer of the State of Florida,
Division of Administrative Hearings. The final order entered by the hearing
officer determined that it was in the public interest to remove the person or
affiliate from the convicted vendor list. (Please attach a copy of the final order.)
The person or affiliate has not been placed on the convicted vendor list.
(Please describe any action taken by or pending with the Department of General
Services.)
(Signature)
Date: �,
STATE OF FLORIDA
COUNTY OF _ 1-6 U lq-r I
The foregoing instrument was acknowledged before me this 23 day of
2001by X4 ! a
e} on behalf of
He /she is P on y kno t me or has produced as
identificati not (L ake an oath_
rrr,, Curtis D. Tiegs
Name: Commission 4DD 457354
�► ..� 10 2006
M Commission Expires.- ;,�. xplres: ,
Y P — •'�`= Ewnded Tiuv
Commission Number: Afl-nt[c s4Rdirig Co., Inc
RUDDER QUALIFICATION QUESTIONNAIRE
Ao'•A. Submittedky Young's Communications Co., Inc.
Name of Bidder
General Contractor's License W cuco 57425
( ) An Individual
{ ) A Partnership
{ ) A Corporation
Federal Identification W 59-1398816
Principal Office Address:
820 E. Seminole Ave.
Melbourne, FL 32901 _
(1) How many years has your organization been in business as a contractor under your present name?
6years as Young's Communications. 25 years Young's TV Cable
(2) How many years experience has your organization had as a directional boring contractor?
12 -13 years
As a Subcontractor?
Young's Communications has been a prime Contractor since inception (1972).
(3) List below the requested information concerning projects your organization has completed in the last five
^MkI (5) years for the type of work required in this project (Use additional sbeets if necessary). include the
type of work similar to the work included in this contract if possible.
Project Contract Required Actual Name/Address/Tel
Title Amount !CoLapletion Date Completion Date of Owner
FFPL lib g%, t 965{} W. Flagler
.lax Metro 4.2mil 04/02 04/02 l�iiami, z igas
TampaMetro 2.8mil 12/2000 11/2000
Same as Above
Melb. Backbone 3.2 mil 12/99 12/99 KMC Telecom, Howard Varness
Daytona Backbone 1.7 mil 10/98
08/98 2300 Commerce Park Dr. Palm Bay, Fl-
(4) . Have you ever failed to complete any work awarded to you? if so, where and wiry?
No
(5) Has any officer or partner of your organization ever been an officer or partner of some other organization
that failed to complete a construction contract? If so, state name of individual, name of other organization,
and reason therefore.
IZ
Sebastian Municipal Airport BQQ -1
(6) Has any officer or partner of your organization ever failed to complete any construction contract handled in
his own name? if so, state name of individual, name of owner and reason therefore.
0
(7) Give below any information which would indicate the size and opacity of your organization, including
number of employees, equipment owned by your organization, etc., which are available for utilization on
this Contract.
(8)
12 employees, 1 V7X11 Bore Rig, 2 V16x2O Bore Rigs, 1 V24X40 Bore Rig
3 Vac Units, Cat 420D Backhoe
What is your bonding capacity? 3 mil lion
(9) What amount of your bonding capacity has been used as of the date of this bad?
$228,000.00
Aoftkl
(14) How many applications for performance and payment bonds leave you made in the last three
(3) yam? One
(11) How many of these applications were not approved? None
(12) Have any claims been filed against your surety bond company in the last five (5) years? If so, describe the
nature of the claims and give the names of the surety companies, dates of each claim, identifying numbers
of each claim, amounts of each claim; and the status of each claim. (Use additional sheets if necessary.)
No
Sebastian Municipal Airport BQQ-2
(13) Have your company been in disputes or litigations in the last five (5) years over construction projects which
.s, are completed or still pending for completion? If so, describe the nature of the disputes or litigations and
state the Owner's Name, Address, Telephone, and amount of disputes or litigations. (Use additional sheets
if necessan,.)
No
L the undersigned, do hereby declare that the foregoing statements are true and correct, all as of
the date hereinafter set forth, and that those examining this document have my permission to
contact any or all of those parties listed in this questionnaire. Incorrect or misleading statements
in this questionnaire shall be grounds for a determination of non - responsibility with respect to
such contractor.
(SIGNATURE OF BIDDER)
Young's Communications Co., Inc.
(TYPE OR PRINT COMPANY NAME)
820 E. Seminole Ave. Melbourne, FL 32901
(TYPE OR PRINT ADDRESS)
Sebastian Municipal Airport BQQ -3
r• x Young's Communications Co., Inc.
820 E. SEMINOLE AVE.• MELBOURNE, FLORIDA 32901
10�.
REFERENCES
KMC Telecom
2300 Commerce Park Drive, Suite 1
Palm Bay, FL 32905
FPL FiberNet
9250 W. Flagler Street
Miami, FL 33174
Bright House Networks
P.O. Box 361016
Melbourne, FL 32936
City Of Melbourne, Water Dept.
2591 Harper Road
Melbourne, FL 32904
NUI City Gas
4180 South US Highway 1
Rockledge, FL 32955
JEA
21 West Church Street, CC5
Jacksonville, FL 32202 -3139
Howard Varness
Construction Mgr. - Florida
321 - 308 -1023
Del Castellanos
Network Deployment Manager
305 -552 -2438
Bob Walton
Construction Manager
321 -757 -6454
Tom Hoagland
Operations Superintendent
321- 674 -5726
Ron Muller
Engineering /Construction Manager
321- 636 -4644 Ext. -240
Bill Rodgers
USC, Info Grid
904 - 665 -7517
Office (321) 723-6025 • Toll Free (877) YCOMINC • Fax (321) 723 -3743 - Email - ycom@ycominc.com
R
i
E,
'I
ale
„
y
I
iur LLi VJ ta: j "A )01V14V
CM /HR /PROCUREMhT 001
099
SM"No
ii��
NOW OF PUACAN ISLAND
PLWHA.SING
GENFJL4L SERVICES
1225 MAIN S7RE'13T- SEBASTIAN, FLORIDA 32958
TEC. HONE (772) 388 -1241 FAX (772) 581 -0149
ENE (772) 589-0743 FAX (772) 589.6880
ADDENDUM # 1
TRENCIUXSS CONDUIT INSTALLATION
DATE: October 23, 2003
TD: All Bidders
This Addendum hereby becomes an integral part of the hid under consideration by you as
a rewndent. The City of Sebastian deeina all Sealed bids to have bees proffierW in
recognition of the entire bid package - including all issued addenda.
This Addendum is being seat to you via -6W. Should you have any queatiou pertaining
to this Addendum, ple-&e contact me at 772 - 589 -0743.
ADDENDUM MESSAGE
I. Please be advise that four inch (4 ") conduit HTPE SDR 13.5 is acceptable material for
this project.
2. Thiss page must be submitted signed, as acimowlcdgernent of receipt, with your bid,
3. ALL OTHER. TERMS AND CONDFTIONS REMAIN THE SAME_
Receipt a"owledged try, Bidders Signature
Page 1 of 1
Firm Name