OFFICIAL BID FORM
PROPOSAL FOR THE PURCHASE OF REVENUE REFUNDING BONDS, SERIES 2015
CITY OF MEDICINE LODGE, KANSAS, PUBLIC BUILDING COMMISSION
TO:
Kandi Williams, Secretary
City of Medicine Lodge, Kansas,
Public Building Commission
Tax Identification No. 86-1159824
September 21, 2015
For $1,035,000* principal amount of Revenue Refunding Bonds, Series 2015, of the City of Medicine Lodge, Kansas, Public
Building Commission (the “Issuer”), to be dated October 15, 2015 (the “Bonds”), as described in your Notice of Bond Sale for the
Bonds dated September 10, 2015, the Bonds will bear interest as follows:
Maturity
September 1
Principal
Amount*
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
$20,000
90,000
90,000
95,000
95,000
100,000
105,000
105,000
110,000
115,000
110,000
Interest
Rate
_____%
_____%
_____%
_____%
_____%
_____%
_____%
_____%
_____%
_____%
_____%
we will pay par value of the Bonds plus accrued interest to the date of delivery, plus a total premium and/or less a discount in the
amount set forth below.
Total interest cost to maturity at the rates specified ......................................
Discount (if any) not to exceed 2.00% ............................................................
Total premium (if any) ....................................................................................
Net interest cost ............................................................................................
Average annual net interest rate .................................................................

$_____________________
$_____________________
$_____________________
$_____________________
____________________%
The Bidder elects to have the following Term Bonds:
Maturity Date
September 1, _____
September 1, _____
Years
_______ to _______
_______ to _______
Amount
$__________
$__________
Subject to mandatory redemption requirements in the amounts and at the times shown above.
This proposal is subject to all terms and conditions contained in said Notice of Bond Sale, and if we are the successful bidder, we
will comply with all the provisions contained in the Notice of Bond Sale. The acceptance of this proposal by the Issuer shall
constitute a contract between the Issuer and the successful bidder.
Submitted by: ____________________________ Signed By: ____________________________
Telephone No.: ___________________________ Email address: _________________________
[LIST ACCOUNT MEMBERS ON REVERSE]
ACCEPTANCE
The above proposal is accepted by action of the Medicine Lodge, Kansas, Public Building Commission on September 21, 2015.
Attest:
_________________________________
Secretary
NOTE:
_____________________________________
Chairperson
No additions or alterations in this official bid form shall be made, and any erasures may cause rejection of any bid. Sealed bids may be
filed with the Issuer’s Financial Adviser for and on behalf of the Issuer, in the manner described in the Notice of Sale for the Bonds, at or
prior to the deadlines stated therein, on Monday, September 21, 2015. Any bid received after such time will be returned to the bidder
unopened.
*Subject to Change
ML PBC RRB 2015 Bid Form Final