JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 1
INVITATION TO BID
Sealed bids marked "MICROBIOLOGY SUPPLIES-COOPER GREEN HOSPITAL" will be
received by the Purchasing Manager, Room 830 * 716 Richard Arrington Jr Blvd N, Birmingham,
Alabama.
Bids will be accepted until 5:00 P.M. central time (standard or daylight savings time, as applicable) on
JUNE 26, 2006. Bids submitted after this date and time will not be considered.
Bids will be publicly opened at 2:00 P.M. on JUNE 27, 2006.
Contracts for Microbiology Supplies required for Jefferson County’s Cooper Green
Hospital for the period 10/1/2006 to 10/1/2007 with County’s option to renew two additional
years each October 1, until October 1, 2009.
The County is not responsible for delays occasional by the U.S. postal Service, the internal mail delivery
system of the County, or any other means of delivery employed by the bidder. Similarly, the County is not
responsible for, and will not open, any bid/proposal responses, which are received later than the date and
time, indicated above. Late bids/proposals will be retained in the bid/proposal file, unopened.
Due to bid evaluation and budgetary procedures, bid awards will not be made prior to October 1,
2006. At that time a Bid Award Notice and Contract Order will be issued to successful bidder.
SCOPE OF CONTRACT
Any purchase order(s) resulting from this ITB will become effective upon bid award (or within 30 days of
award notification); approval of the County Commission and date purchase order is issued. The County
will have the option to renew contract annually for (2) two additional (1) one year terms if mutually agreed.
CONDITIONS
SPECIFICATIONS:
Use of specific names and numbers is not intended to restrict the bidding of any seller and/or
manufacturer, but is solely for the purpose of indicating the type, size and quality of materials, products,
service, or equipment considered best adapted to the County’s intended use.
Proprietary specifications may be waived for functional equivalents offered.
Said functional equivalents are subject to acceptance by the Cooper Green Hospital Medical Staff.
All products are guaranteed by bidder to meet all State and Federal Laws and regulations.
No contract other than the County’s Standard Purchase Order will be signed by Jefferson County
or Cooper Green Hospital.
DELIVERY:
Will be to: Cooper Green Hospital, Amerinet Member
1515 6th Avenue South, Birmingham, AL 35233
CONTINUED ON SHEET 2
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 2
INVITATION TO BID (CONTINUED)
Purchase orders will be issued as deliveries are required.
F.O.B. Destination via best way.
PRICES:
Include transportation
INVOICING
All invoices must agree with the purchase order in description and price and include the following
information:
1) Purchase Order Number; 2) Ship-to department name and address.
In order to ensure prompt payment, ALL ORIGINAL INVOICES* MUST BE SENT TO:
Jefferson County Commission
Finance Department
Room 820 County Courthouse
716 Richard Arrington Jr. Blvd. North
Birmingham, Al 35203
*If invoice does not agree with purchase order, credits or a corrected invoice will be required in order for
the County to process payment.
THIRD-PARTY “REMIT-TO”
If bidder has a third-party “remit-to” company, that information must appear on the Bidder’s response.
Jefferson county will send payment to the company designated by Bidder on its response, but will not be
responsible for resolving payment issues, should the bidder change payment processing companies after a
payment has been mailed or without 45-day written notification to the Purchasing and Accounting division
of Jefferson County.
Failure to deliver as specified and in accordance with the bid submitted, including promised delivery will
constitute sufficient grounds for cancellation of the order at the option of the County Commission.
TERMINATION OF CONTRACT: This contract may be terminated by the County with a thirty (30)
day written notice to the other party regardless of reason. Any violation of this agreement shall constitute a
breach and default of this agreement. Upon such breach, the County shall have the right to immediately
terminate the contract and withhold further payments. Such termination shall not relieve the contractor of
any liability to the County for damages sustained by virtue of a breach by the contractor.
PRICES:
NOTE: DO NOT QUOTE ON ANY ITEM ON WHICH YOU CANNOT OFFER A MINIMUM
ONE YEAR CONTRACT PRICE. ITEMS NOT ON CONTRACT WILL BE PURCHASED AS
NEEDED ON SEPARATE PURCHASE ORDERS.
CONTINUED ON SHEET 3
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 3
INVITATION TO BID
(CONTINUED)
TAX: Jefferson County is exempt from all tax. Provided however, bidder shall be responsible for
payment of all sales, use, lease, ad valorem and any other tax that may be levied or assessed by reason of
this transaction.
If mutually agreed upon, additional contracts may be executed, based upon this bid for the same item(s) or
related types and/or sizes.
In the event of a general price reduction, the County will receive the benefit of such reduction on any
undelivered portion of contract.
Bidder agrees that Jefferson County will be charged no more for item(s) bid than the State of Alabama, and
that in the event of a price reduction; the County will receive the benefit of such reduction on any
undelivered portion of contract.
If requested, bidder will furnish a sample of each item on which he has bid within day(s).
GUARANTEE: Bidder certifies by bidding, that he is fully aware of the conditions of service and
purpose for which item(s) included in this bid are to be purchased, and that his offering will meet these
requirements of service and purpose to the satisfaction of the Jefferson County Commission and its Agent.
INSURANCE
The successful bidder will maintain such insurance as will protect him and the County from claim under
Workmen’s Compensation Acts, and from claims for damage and/or personal injury, including death,
which may arise from operations under this contract. Insurance will be written by companies authorized to
do business in Jefferson County, Alabama and shall include Jefferson County, Alabama as Added
Additional Insured including a thirty (30) day(s) written cancellation notice. Evidence of insurance
will be furnished to the Purchasing agent not later than seven (7) day(s) after Purchase Order/contract date.
Insurance Minimum Coverage:
Contracting party shall file the following insurance coverage and limits of liability with the County’s Risk
Management Office and Purchasing Department before beginning work with the County.
General Liability:
$1,000,000 – Bodily injury and property damage combined occurrence
$1,000,000 – Bodily injury and property damage combined aggregate
$1,000,000 – Personal injury aggregate
Comprehensive Form including Premises/Operation, Products/Completed Operations, Contractual,
Independent contractors, Broad Form property damage and personal injury.
Automobile Liability:
$1,000,000 – Bodily injury and property damage combined coverage
Any automobile including hired and non-owned vehicles
CONTINUED ON SHEET 4
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 4
INVITATION TO BID
(CONTINUED)
Workers Compensation and Employers Liability:
$100,000 – Limit each occurrence
Umbrella Coverage:
$1,000,000 – Each occurrence
$1,000,000 – Aggregate
Added Additional Insured:
Jefferson County, Alabama
30 day(s) written cancellation notice
PUBLIC DISCLOSURE:
Subject to applicable law or regulations, the content of each Bidder’s Proposal shall become public
information upon the effective date of any resulting contract.
BID BOND: Each bidder will furnish a bid bond or cashier's check in the amount of $500.00
GENERAL: The Jefferson County Commission expressly reserves the right to reject any or all bids, or
parts of bids, and to make the award or awards as the best interest of the County appears.
Sandra Tellis
Principal Buyer
CONTINUED ON SHEET 5
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 5
BID
(Bidder must use this form)
Fill in all spaces
NAME OF YOUR COMPANY:___________________________________________
CO.
BRAND
CODE
DESCRIPTION
STK. NO.
NO.
1
API 20E ANALYTICAL PROFILE INDEX # V7100
NO SUBSTITUTE
2
API-OF, 50 AMPULES/PKG, #50110, 10/PK
NO SUBSTITUTE
3
API KOVACD REAGENT, 30 CC/BTL, #V7050
NO SUBSTITUTE
4
API FERRIC CHLORIDE, 30 CC/BTL, #V7052
NO SUBSTITUTE
5
API ALPHA NAPHTOL, 6%, 30 CC/BTL, #V7054
NO SUBSTITUTE
6
API ALPHA NAPHTYLAMINE (0.5%), 30 CC/BTL, API
#V7055, NO SUBSTITUTE
7
API SUFANILIC ACID (0.8%), 30 CC/BTL,
#V7056, NO SUBSTITUTE
8
API POTASSIUM HYDROXINDE (40%), 30 CC/BTL, #V7053
NO SUBSTITUTE
9
API PIPETTE, 5-3/4" Long DISPOSABLE W/4ML BULB,
100/BOX, #V7160
10 API 20 E ENTERIC IDENTIFICATION SYSTEM, "100" PACK,
100 STRIPS/BOX, #20179, NO SUBSTITUTE
11 API 20A ANAEROBE ID, 25/BOX, API #20306,
NO SUBSTITUTE
12 API QUAD FERN SYSTEM,
CAT #V7000, 30/PK, NO SUBSTITUTE
13 BROMCRESOL PURPLE SOLUTION, (0.2%), #V7060
30 CC/BTL NO SUBSTITUTE
14 EHRLICHS REAGENT 15CC/BTL, #V7059 NO SUBSTITUTE
15
16
17
18
19
XYLENE, 15 CC/BTL,
#V7061, NO SUBSTITUTE
BACTI-CLINERATOR ELEMENT, SHERWOOD #14489-2, CMS # 268-391
BIO BAG ENVIRONMENTAL CHAMBER, TYPE A,
MULTIPLATE SIZE, 50/PK, FISHER# 149107 NO SUBSTITUTE
JORGENSEN INOCULATING LOOP HOLDER,
1 HOLDER/PKG, FISHER# 13093
GAS PAK POUCH, 25/PK BBL# L60651 NO SUBSTITUTE
FISHER# 1181610
CONTINUED ON SHEET 6
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 6
INVITATION TO BID (CONTINUED)
NAME OF YOUR COMPANY: ____________________________________
CO.
BRAND
CODE
DESCRIPTION
STK. NO.
NO.
20 BIO BAG ENVIRONMENTAL CHAMBER TYPE CFU
CAMPY POUCH 25/PK BBL# 1181613
21 OXIDASE REAGENT DROPPERS,
50/PK, BBL# 1491016
22 LACTOPHENOL COTTON BLUE REAGENT
DROPPERS, 50/PK BBL# 1491015
23 DOBELL & O'CONNER'S IODINE STAIN DROPPERS, 50/PK
BBL# 1491017
24 KOH REAGENT DROPPERS, 10%,
50/PK, BBL# 1491017
25 CAMPYLOBACTEC AGAR PLATES W/ 5% ANTIMICROBICS
& 10% SHEEP BLOOD, 20/PK, BBL# B21727X
26 INDIA INK DROPPERS, "QA", 50/PK
DEFCO # D7 3569267
27 REAGENT ALCOHOL (ABSOLUTE) 1 GAL,
PLASTIC CONTAINER FISHER# HC600
28 BBL PROMPT INOCULATION SYSTEM,
60/PK, FISHER #B26306
29 REAGENT QC KIT, 30 TEST/KIT,
REMEL CAT# 21-395
30 HAEMOPHILUS ID QUAD W/GROWTH
FACTOR, 10/PK BBL#B978904
31 PORT-A-CUL VIAL TRANSPORT MEDIA, 10/PK
BBL# B21608
32 PORT-A-CUL TUBE-SPECIMEN COLLECTION,
10/PK, BBL# B21606
33 MAC CONKEY II AGAR W/SORBITOL
10/PK, BBL# L97953
34 AMIKACIN DISCS, 50/CTG, 10CTG/PK, 10 MCG,
BBL# B31597
35 CEFOXITIN DISC, 50/CTG, 10CTG/PK,
BBL# B31591
36 AMPICILLIN DISC, 50/CTG, 10 CTG/PK, 10 MCG,
BBL# B31264
37 CEFOTAXIME DISCS, 50/CTG, 30 MCG,
BBL# B31607
38 CEFTAZIDIME DISCS, 50 CTG, 30 MCG,
BBL# B31633
39 MEZLOCILLIN, 10/PK,
BBL# B31615
40 CEPHALOTHIN DISCS, 50/CTG, 10 CTG/PK,
30 MCG BBL# B31271
CONTINUED ON SHEET 7
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 7
INVITATION TO BID (CONTINUED)
NAME OF YOUR COMPANY:
CO.
BRAND
CODE
DESCRIPTION
STK. NO.
NO.
41 CHLORAMPHENICOL DISCS, 50/CTG, 10 CTG/PK,
30 MCG, BBL# B31274
42 CLINDAMYCIN DISCS, 50/CTG, 10 CTG/PK, 15 MCG,
BBL# B31275
43 ERYTHOMYCIN DISCS, 50/CTG, 10 CTG/PK, 15 MCG,
BBL# B31290
44 GENTAMICIN DISCS, 50/CTG, 10 CTG/PK, 10 MCG,
BBL# B31299
45 NEOMYCIN DISCS, 50/CTG, 10 CTG/PK, 10 MCG,
BBL# B31313
46 NITROFURANTOIN DISCS, 50/CTG, 10 CTG/PK, 300 MCG,
BBL# B31293
47 NORFLOXIN DISCS, 50/CTG, 10 CTG/PK, 300 MCG,
BBL# B31647
48 NOVABIOCIN, 50/CTG, 10 MCG,
BBL# B31314
49 PENICILLIN G DISCS, 50/CTG, 10 CTG/PK,
BBL# B31321
50 CEFOTETAN DISC, 500/PK,
BBL# B31656
51 OFLOXACIN 5 MCG DISC, 50/PK
BBL# B31671
52 CEFINASE DISCS BBL# B31650
NO SUBSTITUTE
53 PIPERACILLEN DISC, 50/PK, 10 CART/PK,
BBL# B31609
54 CIPROFLOXACIN DISCS, 10CTG/PK, 5 MCG,
BBL# B31658
55 TETRACYCLINE DISCS, 10 CTG/PK, 30 MCG,
BBL# B31344
56 TOBRAMYCIN DISCS, 50/CTG, 10 MCG,
BBL# B31569
57 AMPICILLIN WITH SULBACTAN 10 CTG/PK, 10/10 MCG,
BBL# B31660
58 TRIMETHOPRIM/SULFAMETHOXIZOLE DISCS,
10 CTG/PK, 25 MCG, BBL# B31539
59 VANCOMYCIN DISCS, 10 CTG/PK,
BBL# B31595
60 CEFAMANDOL DISC, 10 CTG/PK,
BBL# B31595
61 OXACILLIN DISCS, 10 CTG/PK, 85 MCG,
BBL# B31319
CONTINUED ON SHEET 8
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 8
INVITATION TO BID (CONTINUED)
NAME OF YOUR COMPANY:
CO.
CODE
DESCRIPTION
NO.
62 TIMENTIN DISCS, 10 CTG/PK,
BBL# B31649
63 DIFFERENTIATION OPTCHIN DISC, 50/CTG.
BBL# B31048
64 STERILE, INDIVIDUALLY WRAPPED, 1 ML
SEROLOGICAL PIPETTES, 1000/CS, FISHER# 1367610 G
65 3 x 1 INCH, 1.2MM THICK, PRECLEANED FROSTED END
(ONE-SIDE) MICROSCOPE SLIDES, 10 GR/CS,
FISHER# 125443
66 BHI AGAR W / VANCOMYCIN, 10/PK
VBBL# L4322204
67 DIFCO BACTROL DISKS, SET A, 10 VIALS/BOX,
CAT# 1628-32-2
68 DIFCO BACTROL DISKS, SET C, 6 VIALS/BOX,
CAT# DF 1656327
69 STREPTEX KIT (GROUP A, B, C, D, F, & G), 75 TEST/PK
BBL# B40860
70 DISPOSABLE STERILE INNOCULATING LOOPS/NEEDLE,
1 BX = 1000 STERILE LOOPS W/NEEDLES, 50 BAGS/20
LOOPS EA, CLEAR 1 VL SIZE, FISHER# 22251457
71 PATHO DX STREP GROUPING KIT, 60 TEST/KIT
CAT# 62025, REMEL# 62025
72 NEISSERIA GONORRHOEAE ATCC 31426 5/PK
CAT# 4607042
73 NEISSERIA LACTAMICA ATCC 23971 5/PK CAT# 4607045
74
NEISSERIA MUCOSA ATCC 19695 5/PK CAT# 4607150
75
BRANHAMELLA CATARRHALIS ATCC 25240 5/PK
CAT# 4601231
BACTEROIDES OVATUS ATCC 8483 5/PK CAT# 4601222
76
77
78
79
80
81
CLOSTRIDIUM PERFRINGENS ATCC 13124 5/PK
CAT# 4601600
CLOSTRIDIUM HISTOLYTICUM ATCC 19401 5/PK
CAT# 4601601
CLOSTRIDIUM SORDELL ATCC 9714 5/PK CAT# 4609015
STREPTOCOCCUS PNEUMONIAE ATCC 49619 5/PK
CAT# 4609015
REAGENT QC KIT 30 PER KIT, REMEL CAT# 21395
Delivery is guaranteed not later than _______days after order date
CONTINUED ON SHEET 9
BRAND
STK. NO.
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 9
BID(CONTINUED)
NAME OF YOUR COMPANY:
CO.
CODE
DESCRIPTION
NO.
82 CARBOL FUSCIN STAIN 250 ML CAT. 4312511
83
METHYL BLUE STAIN 250 ML CAT. 4312516
84
ACID ALCOHOL 250 ML CAT. 4312517
85
INDIA INK CONTROLS:
POSITIVE GIB 100111----NO SUBSTITUTIONS PLEASE
NEGATIVE GIB 100112—NO SUBSTITUTIONS PLEASE
FLORESCENT STAIN KIT 3 BOTTLES /KIT CAT 4312521
86
87
TEST KIT H. PYLORI GII QUICKVUE 3, 30 TEST KIT
CAT. B1042-49 (CARDINAL)
88-A IDS RAPID NH SYSTEM #8311001 (REMEL)
B
IDS INNOCULATION FLUID #8325102(REMEL)
C
IDS NITRATE A #8309003
D
IDS NITRATE B # 8309004
E
IDS SPOT INDOLE #839002
F
IDS NH QC BUG SET #4653051
89 LEVOFLOXCIN DISC CAT. 33215 (REMEL)
90 QC ORGANISM SET CAT 4653051
91 ETEST STRIP PEN G, 100/PK CAT. 510268
92
PATHO DX STREP GROUP KIT CAT. 62025
93
NEISSERIA GONORRHOEAE ATCC 31426 5/PK CAT 4607042
94
BACTEROIDES OVATUS ATCC 84835 5/PK CAT 4601222
95
STAPH AUREUS ATCC 29213 CAT 4907011
96
E. COLI ATCC 25922 CAT 4607050
97
CANDIDA ALBICANS ATCC 60193 OR 10231
98
T MENTAGROPHYTES ATCC 9533 CAT 4608300
99
100
STENOTROPHOMONAS MALTOPHILIA ATCC 51331 CAT 19367
ENT CLOACAE ATCC 13047 CAT. 4607090
101
102
PROT. MIRABILIS ATCC 35659 CAT. 19-237
KLEB. P. SSP. PNEUMONIAE ATCC 35657 CAT 4603922
BRAND
STK. NO.
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
CONTINUED ON SHEET 10
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 10
BID (CONTINUED)
CO.
CODE
DESCRIPTION
NO.
103 GASPAK EZ ANAEROBE GAS POUCH SYSTEM
CAT. 4360683, 20 SYSTEMS PER EACH
104
GASPAK EZ CAMPY GAS POUCH SYSTEM, CAT. # 4360685,
20 SYSTEMS PER EACH
105
PIPERACILLIN/TAZOBACTAM DISKS, 50/CT 100 MCG/10
MCG, CAT # 4331692
106
AMICILLIN/CLAVULANIC ACID DSKS, 50/CT DISKS,
10CTG/PK 30 MCG. CAT. #R33995
107
MICROSCAN GRAM NEGATIVE QC PANEL 4/SET (ST)
CAT #RR4661000
108
MICROSCAN GRAM POSITIVE QC Panel 4/SET (ST)
CAT #RR4661001
BRAND
STK. NO.
PKG. QTY.
MIN. ORDER
QTY.
PKG. PRICE
PRICE EACH
109
E. COLI QC ATCC 35218 5/PK, CAT #4601971
110
GASPAK ANAEROBIC DRY INDICATOR STRIPS, 100/PK,
CAT #J305-21
If price increase is applicable in subsequent years (10/1/07 to 10/1/08 and 10/1/08 to 10/1/09) then pricing
is guaranteed not to increase more than ____%. All price increases must be received at least thirty (30)
days prior to expiration period and clearly marked as such.
CONTINUED ON SHEET 11
JEFFERSON COUNTY COMMISSION
PURCHASING DEPARTMENT
ROOM 830 * 716 RICHARD ARRINGTON JR BLVD N
BIRMINGHAM, AL 35203
(205) 325-5382
PRINCIPAL BUYER: SANDRA TELLIS
JUNE 7, 2006
BID NO: 233-06
SHEET NO: 10
BID
(CONTINUED)
The Jefferson County Commission, or its Agent, shall have the right to waive any informality or irregularity. Under
certain limited conditions, the Purchasing Department may apply a local preference option in determining the low
bid for purchases of personal property.
All provisions of this Invitation are accepted by bidder as part of any contract or purchase resulting therefrom.
Please specify terms of payment below; otherwise, the terms will be 2% 10th Prox.
Date:_______Company Name:________________________________Web Address:__________________
Terms:_______Address:________________________________________City:_____________________
County:_______________State:_____Zip:____________Phone:(_____)___________________________
If Jefferson County Business Licenses were issued to your company for the past twelve (12) months, please list
numbers:_____________________________________________.
Vendor's Federal I.D. Number:____________________________
I certify that ___________________________ has ___ has not ___ been in operation for one year at
(Company Name)
(Check one)
location(s) zoned for the type of business conducted by my company at the address stated above.
______________________________
(Authorized Signature)
______________________________
(Print Name)
______________________________
(E-Mail Address)
Toll Free Phone:_____________________________Fax Number:_________________________________
Return original bid in sealed envelope. Authorized signature of bidder must be in ink.
Bids received in our office after the specified date and hour will not be considered.
INDICATE THE FOLLOWING ADDRESSES IF DIFFERENT FROM ABOVE:
1. BID AWARD NOTICE ADDRESS
2. PURCHASE ORDER ADDRESS
3. REMITTANCE ADDRESS (AND NAME IF DIFFERENT THAN ABOVE)