Attachment 2
CERTIFICATION OF TIPPING AND/OR RECYCLABLE PROCESSING FEES
RFP 22760, Recycling and Trash Removal Services (Group 79013)
Instructions:
This form must be filled out for each trash disposal site or recycler who is providing services to the bidder. Please
provide the information requested in each numbered request in the space provided below and then sign and notarize
the form. Any Bidder who fails to submit responses to the questions may be deemed nonresponsive and may be
denied further consideration for Contract award.
1. Location of Trash Disposal Facility or Recycling Facility
The bidder shall provide the name and address of the facility where the trash or recyclables will be delivered.
2. Contact Person at Facility
The bidder shall provide a contact name, phone number and email for the facility.
3. Regions and Lots that the Facility will Service and Tipping and/or Recyclable Processing
Fees
The bidder shall list the regions and lots that the facility will service and the tipping and/or recyclable processing
fees associated with the regions and lots.
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Attachment 2
CERTIFICATION OF TIPPING AND/OR RECYCLABLE PROCESSING FEES
RFP 22760, Recycling and Trash Removal Services (Group 79013)
I, ________________________________________,
(Officer of the Corporation)
attest to the validity and accuracy of the tipping and/or recyclable processing fees listed in this
document between ____________________________________________ (company name) and
________________________________________ (dump and/or recycling site name) and certify
that the Tipping Fees, Recyclable Processing Fees and/or Haul Charges provided in my bid are
based on delivering trash and/or recyclables to the facility listed for the Regions and Lots specified.
_______________________________________________________
(Signature)
_______________________________________________________
(Company Name)
_______________________________________________________
(Date)
(
If
a
corporation):
__he
is
the
_____________________
of
____________________________, the corporation awarded a contract to provide Rubbish
Removal pursuant to the above-referenced Contract. By authority of the Board of Directors of
said corporation, __he is authorized to certify compliance with the Statewide Contract terms and
conditions on behalf of the corporation; and that, pursuant to that authority, __he executed the
foregoing in the name of and on behalf of said corporation as the act and deed of said corporation.
( If a partnership): __he is the _______________________ of ______________________,
the partnership awarded a contract to provide Rubbish Removal pursuant to the above-referenced
Contract. By the terms of said partnership, __he is authorized to certify compliance with the
Statewide Contract terms and conditions on behalf of the partnership; and that, pursuant to that
authority, __he executed the foregoing in the name and on behalf of said partnership as the act and
deed of said partnership.
( If a Limited Liability Company):
___he is a duly authorized member of
___________________, LLC, the limited liability company awarded a contract to provide Rubbish
Removal pursuant to the above-referenced Contract. By authority of the LLC, __he is authorized
to certify compliance with the Statewide Contract terms and conditions on behalf of the limited
liability company; and that, pursuant to that authority, _he executed the foregoing in the name of
and on behalf of said limited liability company as the act and deed said limited liability company.
Signed this_______ day of ____________________, 200__
_________________________________
Notary Public
___________________________________________
Registration No.
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