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LEGAL NOTICE AND INVITATION TO BID BID #060-20 Sealed bids will be received by the PUBLIC UTILITIES BOARD of the City of Brownsville, Texas ("BPUB"), for Electrical and Electronic Spare Parts until 5:00 PM, August 19, 2020 at the BPUB Purchasing Office; 1155 FM 511, Olmito, Texas 78575. Bids received after this time will not be considered. Bids will be publicly opened and read aloud on August 20, 2020 at 11:00 AM. Vendors may call in at 11:00 AM, August 20, 2020 to (956) 214-6020 to listen to the bid opening. Copies of the Specifications may be obtained at the BPUB website: https://www.brownsville-pub.com/rfp_status/open/ Two (2) sets of the bid documents shall be enclosed in a sealed envelope and shall be plainly marked on the outside of the envelope and on any carrier’s envelope : “B060- 20 Electrical and Electronic Spare Parts, August 19, 2020, 5:00 PM”. This envelope shall be addressed to Diane Solitaire; Brownsville Public Utilities Board; Purchasing Department; 1155 FM 511; Olmito, Texas 78575. The BPUB will not be responsible in the event that the U.S. Postal Service or any other courier system fails to deliver the sealed bids to the Brownsville Public Utilities Board, Purchasing Office by the given deadline above. No bids will be accepted via facsimile or electronic submission. The BPUB specifically reserves the right to reject any or all bids, to waive irregularities or informalities in any or all bids and to accept any bid which is deemed to be in the best interest of the Board. By: Diane Solitaire Purchasing Department (956) 983-6366 - Phone (956) 983-6367-Fax

LEGAL NOTICE AND INVITATION TO BID BID # 060-20 Bids ... · LEGAL NOTICE . AND . INVITATION TO BID . BID # 060-20 . Sealed bids will be received by the PUBLIC UTILITIES BOARD of the

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Page 1: LEGAL NOTICE AND INVITATION TO BID BID # 060-20 Bids ... · LEGAL NOTICE . AND . INVITATION TO BID . BID # 060-20 . Sealed bids will be received by the PUBLIC UTILITIES BOARD of the

LEGAL NOTICE AND

INVITATION TO BID BID #060-20

Sealed bids will be received by the PUBLIC UTILITIES BOARD of the City of Brownsville, Texas ("BPUB"), for Electrical and Electronic Spare Parts until 5:00 PM, August 19, 2020 at the BPUB Purchasing Office; 1155 FM 511, Olmito, Texas 78575. Bids received after this time will not be considered. Bids will be publicly opened and read aloud on August 20, 2020 at 11:00 AM. Vendors may call in at 11:00 AM, August 20, 2020 to (956) 214-6020 to listen to the bid opening. Copies of the Specifications may be obtained at the BPUB website: https://www.brownsville-pub.com/rfp_status/open/

Two (2) sets of the bid documents shall be enclosed in a sealed envelope and shall be plainly marked on the outside of the envelope and on any carrier’s envelope: “B060-20 Electrical and Electronic Spare Parts, August 19, 2020, 5:00 PM”. This envelope shall be addressed to Diane Solitaire; Brownsville Public Utilities Board; Purchasing Department; 1155 FM 511; Olmito, Texas 78575. The BPUB will not be responsible in the event that the U.S. Postal Service or any other courier system fails to deliver the sealed bids to the Brownsville Public Utilities Board, Purchasing Office by the given deadline above. No bids will be accepted via facsimile or electronic submission. The BPUB specifically reserves the right to reject any or all bids, to waive irregularities or informalities in any or all bids and to accept any bid which is deemed to be in the best interest of the Board. By: Diane Solitaire Purchasing Department (956) 983-6366 - Phone (956) 983-6367-Fax

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Please submit this page upon receipt. Acknowledgement Form

B060-20 Electrical and Electronic Spare Parts For any clarifications, please contact Nicole Espinoza at the Brownsville Public Utilities Board, Purchasing Department at (956) 983-6353 or via e-mail: [email protected] Please fax, mail or e-mail this page upon receipt of the bid legal notice. If you only received the legal notice and you want the bid package mailed, please provide a method of shipment with account number in the space designated below. Check one: ( ) Yes, I will be able to send a bid; obtained bid package from website. ( ) Yes, I will be able to send a bid; please email the bid package. Email: ( ) Yes, I will be able to send a bid; please mail the bid package using the carrier & account number listed below: Carrier:

Account: ( ) No, I will not be able to send a bid for the following reason:

If you are unable to send your bid, kindly indicate your reason for “No bid” above and return this form via email to: [email protected]. This will ensure you remain active on our vendor list. Date Company:

Name:

Address:

City: State: Zip Code:

Phone: Fax:

E-mail: ___________________________________________________________

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Special Instructions

Contract Information

• Interpretation

Questions concerning terms, conditions and technical specifications should be directed to:

Nicole Espinoza, Purchasing or Diane Solitaire, Materials/Warehouse Manager (956) 983-6353 (956) 983-6366

• Tentative Time line

1. August 3, 2020 to August 19, 2020 - Vendors work on formal bid. 2. August 19, 2020 before 5:00 PM - Vendor must submit two (2) sets of bid

documents to:

Diane Solitaire, Purchasing 1155 FM 511 Olmito, Texas 78575 B#060-20 Electrical and Electronic Spare Parts Due: August 19, 2020 at 5:00 PM

The above noted information must be included on formal bid and on any carrier’s envelope/package. The Brownsville Public Utilities Board will not be held responsible for missing, lost or late mail. Brownsville Public Utilities Board will not accept facsimile or electronic transmission of informal bid.

3. August 10, 2020 - Last Day to Submit questions 4. August 20, 2020 - Open bids at 11:00 AM 5. August 20, 2020 – September 4, 2020 - Evaluate bids 6. September 10, 2020 - Provide Final Recommendations 7. October 12, 2020 - Send to Utilities Board for approval

• Or Equal

Brand name or manufacturer’s reference used in this request is descriptive – not restrictive- it is intended to indicate type and quality desired. Brands of like nature and quality will be considered. If bidding on other than referenced specifications please provide complete descriptive information of said item. Items on cost sheet must be the exact brand and part number listed.

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• Pricing Bid unit price on quantity specified, extend and show total. In case of errors in extension, unit prices shall govern. Price shall remain firm for 12 months after receipt of purchase order. All fields (UNIT PRICE, TOTAL PRICE, EST. DELIVERY IN DAYS, MANUFACTURER, & PART #) on the specifications pages must be filled. The data must be complete to identify the bidding brand.

• Vendor Representative The successful vendor agrees to send a personal representative with binding authority for the company to the Brownsville Public Utilities Board upon request to make adjustments and/or assist with coordination of all transactions as needed.

• Quality of Products All items must be new, in first class condition, including containers suitable for shipment and storage. No substitutions in standard grades or lesser quality will be accepted.

• Determining Factors for Award

1. Bidders net price on bid items 2. Stock availability 3. Reputation of brand names offered 4. Delivery 5. Safety record will be considered when determining the responsibility of

the bidder

• Contract with Vendor/Entity Indebted to BPUB

It is a policy of the BPUB to refuse to enter into a contract or other transaction with an individual, sole proprietorship, joint venture, Limited Liability Company or other entity indebted to BPUB.

• Vendor ACH (Direct Deposit) Services

The BPUB has implemented a payment service for vendors by depositing the payment directly to the vendor’s bank account. Successful vendor(s) will be required to receive payments directly through Automated Clearing House (ACH) in lieu of a paper check. Return the Direct Deposit Authorization Form with the bid response. The awarded vendor must agree to receive payments via ACH (Direct Deposit).

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• Tax Identification Number (TIN)

In accordance with IRS Publication 1220, a W9 form, or a W8 form in cases of a foreign vendor, will be required of all vendors doing business with the Brownsville PUB. If a W9 or W8 form is not made available to Brownsville PUB, the first payment will be subject to income tax withholding at a rate of 28% or 30% depending on the U.S. status and the source of income as per IRS Publication 1220. The W9 or W8 form must be included with bid response. Attached are sample forms.

• Taxes

The Brownsville Public Utilities Board is exempt from Federal Excise Tax, State Tax and Local taxes. Do not include tax in the bid. If it is determined that tax was included in the bid, it will not be included in the tabulation or any awards. Tax exemption certificates will be furnished upon request.

• Signing of Bid

Failure to manually sign bid will disqualify it. Person signing bid should show title or authority to bind their firm to a contract.

• EEOC guidelines

During the performance of this contract, the contractor agrees not to discriminate against any employee or applicant for employment because of race, national origin, age, religion, gender, marital or veteran status or physically challenging condition.

• As Needed Basis

Quantities shown are estimates only and are based on average usage. Items are to be ordered “as needed” and be billed as such. BPUB will not accept full order of items requested.

• Living Wage Statement

On April 16, 2007, the BPUB Board of Directors approved a local “living wage” policy that requires all Contractors and Subcontractors performing 100% Non-Federally funded Work for the BPUB to pay a minimum wage rate of $8.00/hour. The BPUB requires that all Contractors and Subcontractors comply with this policy.

• Contract and Purchase Order

A contract for the Electrical and Electronic Spare Parts will be placed into effect by means of a purchase order issued by Brownsville Public Utilities Board after tabulation and final approval by the BPUB Board of Directors.

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• Delivery

Delivery of the material will only be accepted during normal working hours, Monday thru Friday, 8 AM to 4 PM. A delivery ticket must be furnished with each delivery by the carrier. The delivery ticket must show the BPUB's Purchase Order, number of crates, packages, etc. being delivered to BPUB. A packing list must be furnished with each delivery by the carrier. The packing list must include the BPUB's Purchase Order number, a brief description of materials and the total number of crates, size, etc. being delivered to BPUB.

• Brownsville Public Utilities Board Rights

1. If only one or no bid is received by "submission date", the BPUB has the right to

reject, re-bid, accept and/or extend the bid by up to an additional two (2) weeks from original submission date.

2. The right to reject any/or all bids and to make award as they may appear to be advantageous to the Brownsville Public Utilities Board.

3. The right to hold bid for 90 days from submission date without action, and to waive all formalities in bid.

4. The right to extend the total bid beyond the original 90-day period prior to an award, if agreed upon in writing by all parties (BPUB and vendor/contractor) and if bidder/vendor holds original bid prices firm.

5. The right to terminate for cause or convenience all or any part of the unfinished portion of the Project resulting from this solicitation within Thirty (30) calendar days written notice; for cause: upon default by the vendor/contractor, for delay or non-performance by the vendor/contractor; or if it is deemed in the best interest of the BPUB for BPUB’s convenience.

6. The right to increase or decrease quantities. In bid, stipulate whether an increase or decrease in quantities will affect bid price.

• Corrections

Any interpretation, correction, or change to the invitation to bid will be made by ADDENDUM. Changes or corrections will be issued by the Brownsville PUB Purchasing Department. Addenda will be faxed or e-mail to all who have returned the Bid Acknowledgement Form. Addenda will be issued as expeditiously as possible. It is the responsibility of the vendors to determine whether all addenda have been received. It will be the responsibility of all respondents to contact the Brownsville PUB prior to submitting a response to the invitation to bid to ascertain if any addenda have been issued, and to obtain any all addenda, execute them, and return addenda with the response to the invitation to bid. Addenda may be posted on BPUB’s webpage.

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COST SHEET B#060-20 Electric and Electronic Spare Parts Items on cost sheet must be the exact brand and part number listed

COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME &

MANUFACTURER # LEAD TIME

L0001-00

STARTER, SIZE 00 NEMA 1 120VAC | SQUARE D MODEL# 8536-SAG12-V02S ALLEN BRADLEY# 509-TODA2E (TO INCLUDE TWO LUG NUT KITS# 140G-M-TLA23) EA 5

L0002-00

STARTER, SIZE 0 NEMA 1 120VAC | SQUARE D MODEL# 8536-SBG2-V02S ALLEN BRADLEY# 509-AOD-A2F (TO INCLUDE TWO LUG NUT KITS# 140G-M-TLA23) EA 5

L0003-00

STARTER, SIZE 1 NEMA 1 120VAC | SQUARE D MODEL# 8536-SCG3-V02S ALLEN BRADLEY MODEL# 509-BOD-A2F (TO INCLUDE TWO LUG NUT KITS# 140G-M-TLA23 EA 20

L0004-00

STARTER, SIZE 2 NEMA1 120VAC | SQUARE D MODEL# 8536-SDG1-V02S ALLEN BRADLEY MODEL# 509-COD-A2J (TO INCLUDE TWO LUG NUT KITS# 140G-M-TLA23) OPEN SIZE 2 #8536-SD01-VO2S, OPTION 8536-SDG1-V02S EA 14

L0005-00

STARTER, SIZE 3 NEMA 1 120VAC | SQUARE D MODEL# 8536-SEG1-V02S SQUARE D SIZE 3 8536-SE01-V02S; 8536SE01S ALLEN BRADLEY #509-DOD-A2L (TO INCLUDE TWO LUG NUT KITS #140G-M-TLA23) EA 6

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0006-00

STARTER, SIZE 4 NEMA 1 120VAC | SQUARE D MODEL# 8536-SFG1-V02S *MUST BE EXACT* EA 5

L0007-00

ROTOFLOAT, MERCURY FREE TYPE S 40 FEET CORD | NORMALLY OPEN, MODEL# S40NO EA 20

L0008-00

ROTOFLOAT, MERCURY FREE TYPE S 60 FEET CORD | NORMALY OPEN, MODEL# S60NO EA 20

L0009-00

ROTOFLOAT, MERCURY FREE TYPE S 80 FEET CORD | NORMALLY OPEN, MODEL# S80NO EA 30

L0010-00

ROTOFLOAT, MERCURY FREE TYPE S 80 FEET CORD | NORMALLY CLOSE, MODEL# S80NC EA 6

L0011-00 RELAY, 3 PHASE MONITOR 8 PIN 480VAC | 1 CONTACT, TIME MARK MODEL# A258B EA 40

L0012-00 RELAY, 3 PHASE MONITOR 8 PIN 240VAC | 1 CONTACT , TIME MARK MODEL# 257B EA 40

L0013-00 RELAY, PHASE MONITOR 11 PIN 240VAC | 2 CONTACT, TIME MARK# 2522BM EA 40

L0014-00 RELAY, 120VAC | TIME MARK MODEL# A471-24V EA 10

L0015-00

BREAKER, SINGLE POLE | ALLEN BRADLEY MODEL# 1492-SPM1C200 SQUARE D MODEL #QOU120 20AMP EA 20

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0016-00 BREAKER, 3 POLE | SIEMENS MODEL# CQD340 EA 15

L0017-00 BREAKER, 3 POLE | SIEMENS MODEL# CQD360 EA 12

L0018-00 BREAKER, 3 POLE | SIEMENS MODEL# CQD380 EA 15

L0019-00

ENCLOSURE, FIBERGLASS 30X24X10 | 3 POINT LATCH AND LOCK NEMA 4X STAHLIN MODEL# N30208FHLWT, HOFFMAN MODEL# A30H2410GQRLP3PT EA 3

L0020-00

ENCLOSURE, FIBERGLASS 36X30X12 | 3 POINT LATCH AND LOCK NEMA 4X HOFFMAN MODEL# A36H3012GQRLP3PT EA 3

L0021-00

ENCLOSURE, FIBERGLASS 24X24X8 | 3 POINT LATCH AND LOCK NEMA 4X HOFFMAN MODEL# A24H2408GQRLP3PT EA 3

L0022-00

CIRCUIT BREAKER, 3 POLE 100A | SQUARE D 600VAC MODEL# FAL36100 ALLEN BRADLEY 600VAC MODEL# 140G-G2C3-D10 EA 3

L0024-00

CIRCUIT BREAKER, 3 POLE 15A | SQUARE D 600VAC MODEL# HDL36015 ALLEN BRADLEY MODEL# 140G-G2C3-C15 EA 6

L0025-00

CIRCUIT BREAKER, 3 POLE 70A | SQUARE D 600VAC MODEL# FAL34070 ALLEN BRADLEY MODEL# 140G-G2C3-C70 EA 10

L0026-00

CIRCUIT BREAKER, 3 POLE 80A | SQUARE D 600VAC MODEL# HDL36080 ALLEN BRADLEY MODEL# 140G-G2C3-C80 EA 6

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0027-00

DISTRIBUTION BLOCK, 3 POLE HEAVY DUTY 600VAC | ILSCO MODEL# PDB-11- 2/0-3 ALLEN BRADLEY MODEL# 1492-PD3141 EA 60

L0028-00

DISTRIBUTION BLOCK, 1 POLE HEAVY DUTY 600VAC | ILSCO MODEL# PDB-14-2/0-1 MODEL# 1492-100Y EA 30

L0029-00

RELAY, 8 PIN SOCKET TYPE 10A 120VAC | SQUARE D MODEL# 8501KPR12P14V20 ALLEN BRADLEY MODEL# 700-HA32A14 TO INCLUDE LED INDICATOR EA 100

L0030-00

RELAY, 8 PIN SOCKET TYPE 10A 24VAC | SQUARE D MODEL# 8501KPR12P14V14 MODEL# 700-HA32A24 EA 100

L0031-00

RELAY, 8 PIN SOCKET TYPE 10A 12VDC | SQUARE D MODEL# 8501KPDR12P14V51 ALLEN BRADLEY MODEL# 700-HA32Z12 EA 20

L0032-00

RELAY, 8 PIN SOCKET TYPE 10A 24VDC | SQUARE D MODEL# 8501KPDR12P14V53 ALLEN BRADLEY MODEL# 700-HA32Z24 EA 20

L0033-00

CIRCUIT BREAKER, 3 POLE NEMA 1 800AMP 600VAC | CUTLER HAMMER MODEL# HND3800T36W ALLEN BRADLEY MODEL# 140G-M6F3-D80 EA 1

L0034-00

CONTROL PUMP, DUPLEX INTRINSICALLY INPUTS 120VAC | DIVERSIFIED ELECTRONICS MODEL# ARM-120-AFE EA 22

L0035-00

CONTROL PUMP, TRIPLEX INTRINSICALLY INPUTS 1420VAC | DIVERSIFIED ELECTRONICS MODEL# ARM120ADE EA 6

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0036-00

TRANSDUCER, 10 PSI LEVEL 80 FEET 4-20MA | CONTEGRA PART# SLX130-M-15-10-100-BT EA 6

L0037-00

TRANSDUCER, 15 PSI LEVEL 80 FEET 4-20MA | CONTEGRA PART# SLX130-M-15-15-100-BT EA 6

L0038-00

PIPE 2" X 10' RIDGID, GALVANIZED | METAL, MODEL# GALV2 ALLIED TUBE & CONDUIT MODEL# RIG200 FT 200

L0039-00

PIPE 3" X 10' RIDGID, GALVANIZED | METAL, GALV3, ALLIED TUBE & CONDUIT MODEL# RIG300 FT 200

L0040-00

UNI-STURT 7/8 SS 316 10' SECTION C | MODEL# P1000TSS, ALLIED TUBE & CONDUIT MODEL# STRUT7/8 SS SLOTTED 10 FT 200

L0041-00

UNI-STRUT 5/8 SS 316 10' SECTION C | ALLIED TUBE & CONDUIT MODEL# STRUT 1-5/8 SS SLOTTED 10 FT 200

L0045-00

PLC CONTROLLER PROGRAMMABLE LOGIC 120VAC | 1400 MICROLOGIC, ALLEN BRADLEY MODEL# 1766-L32AWA EA 5

L0046-00

PLC CONTROLLER PROGRAMMABLE LOGIC 120VAC | 1100 MICROLOGIC, ALLEN BRADLEY MODEL# 1763-L16AWA EA 2

L0047-00 MODULE, DIGITAL INPUT 120VAC | ALLEN BRADLEY MODEL# 1762-IA8 EA 2

L0048-00 MODULE, DIGITAL INPUT 120VAC | ALLEN BRADLEY MODEL# 1762-OA8 EA 2

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0049-00

MODULE, EXPANSION ANALOG INPUT 4-20MA | ALLEN BRADLEY MODEL# 1762-IF4 EA 2

L0050-00 MODULE, OUPUT 4-20MA | ALLEN BRADLEY MODEL# 1762-OF4 EA 2

L0051-00 POWER SUPPLY, 24VDC 2-5A | DIN RAIL, ALLEN BRADLEY MODEL# 1606-XLE120EN EA 4

L0052-00 POWER SUPPLY, 12VDC 2-5A | DIN RAIL, ALLEN BRADLEY# 1606-XLP50B EA 3

L0053-00

RELAY, TIME DELAY 120VAC | TIME MARK MODEL# 310-120V ALLEN BRADLEY MODEL# 700-HT OR AB 700-HR52TA17 EA 5

L0054-00

SURGE PROTECTOR 120VAC | SQUARE D MODEL# D120VIP ALLEN BRADLEY MODEL# 4983-DS120-801 EA 12

L0055-00 ALTERNATOR, TRIPLEXOR 120VAC | FLYGT MODEL# 14403220 EA 1

L0056-00 PHASE MONITOR 240V | FLYGT MODEL# 14403212 EA 10

L0057-00

RELAY, 120VAC | INTRINSICALLY SAFE, FLYGT MODEL# 14403222 OR MPE-030-120-118 EA 12

L0058-00

CIRCUIT BREAKER, 3 POLE 30A 600VAC | EATON MODEL# EHD3030L, 140G-G2C3-C30 EA 2

L0059-00

CIRCUIT BREAKER, 3 POLE 50A 600VAC | SIEMENS MODEL# ED63B050MX, 140G-G2C3-C50 EA 2

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0060-00 PROTECTION DEVICE 120VAC | EBARRA, MTS MODEL# MOS-1PE EA 10

L0062-00

CIRCUIT BREAKER, 3 POLE 60A | MOLDED CASE, ALLEN BRADLEY MODEL# 140G-G2C3-C60 (TO INCLUDE TWO LUG NUT KITS# 140G-G-TLC13 LUGS) EA 1

L0063-00

CIRCUIT BREAKER, 3 POLE 40A 600VAC | MOLDED CASE, ALLEN BRADLEY MODEL# 140G-G2C3-C40 (TO INCLUDE TWO LUG NUT KITS # 140G-G-TLC-13 LUGS) EA 1

L0064-00

CIRCUIT BREAKER, 3 POLE 20A 600VAC | MOLDED CASE, ALLEN BRADLEY MODEL# 140G-G2C3-C20 (TO INCLUDE TWO LUG NUT KITS# 140G-G-TLC13 LUGS) EA 1

L0065-00 VFD, 100HP 480VAC | ALTIVAR VFD MODEL# ATV75HD75N4 EA 1

L0066-00 STARTER, 300HP 480VAC | BENSHAW SOFT STARTER MODEL# RB2-1-S-361-16C EA 1

L0067-00 STARTER, 200HP 480VAC | BENSHAW SOFT STARTER MODEL# RB3-1-S-240A-15C EA 1

L0068-00 STARTER, 100HP 480VAC | BENSHAW SOFT STARTER MODEL# RB2-1-S-096A-13C EA 1

L0069-00 STARTER, 160HP 480VAC | ALTIVAR SOFT STARTER MODEL# ATS48C25Y EA 1

L0070-00 REACTOR, 3 PHASE 60HP 480VAC | FOR VFD, MTE CORP MODEL# RL-08002 EA 2

L0071-00

PROTECTION DEVICE | FLYGT PUMP, MINICAS FLYGT MODEL #14-407129 OR MPE-PMR2 EA 20

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0072-00

GLOVES, XL DISPOSABLE NITRILE 9MIL | HARDY MODEL# 68512 NITRI-COR PLATINUM 8MIL STYLE 4097 BX 150

L0073-00 HORN, 120V | FEDERAL SIGNAL MODEL# 350WB120 | HLA HORN 120V EA 30

L0074-00

LED, 120VAC | RE D, EDWARDS SIGNALING MODEL# 105XBRMR120A | HLA LED LIGHT TO INCLUDE MOUNTING BASE 105 PM PIPE MOUNT ATTACHMENT EA 30

L0075-00

RELAY, 11 PIN 120VAC 10A | SOCKET TYPE, SQUARE D MODEL# 8501KPR13P14V20 ALLEN BRADLEY MODEL# 700-HA33A1 EA 100

L0076-00

RELAY, 11 PIN 24VAC 10A | SOCKET TYPE, SQUARE D MODEL# 8501KPR13P14V14 ALLEN BRADLEY MODEL# 700HA33A24 EA 100

L0077-00

RELAY, 11 PIN 24VDC 10A | SQUARE D MODEL# 8501KPDR13V53 ALLEN BRADLEY MODEL# 700-HA33Z24 EA 20

L0078-00

RELAY, 8 PIN 600VAC | SOCKET BASE, DIN RAIL, FINDER MODEL# 8501NR52 ALLEN BRADLEY MODEL# 700-HN100 EA 20

L0079-00

RELAY, 11 PIN 600VAC | SOCKET BASE DIN RAIL MOUNT, FINDER MODEL# 8501NR61 ALLEN BRADLEY MODEL# 700-HN101 OR FINDER 90.21 EA 110

L0080-00

LED, 120V-130V | RED, PHILIPS LED MODEL# ES60A19DL4PK FOR HIGH LEVEL ALARM LIGHT BULB EA 100

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0081-00

NUT 1/4" SPRING, STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PSRS-1/4-SS EA 50

L0082-00

NUT 1/4" SPRING, STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PSRS-3/8-SS EA 50

L0083-00

NUT 5/16" SPRING, STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PSRS-5/16-SS EA 50

L0084-00

NUT 1/2" SPRING, STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PSRS-1/2-SS EA 50

L0085-00

CLAMP, 1 1/2" STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PS1100-1-1/2-SS EA 50

L0086-00

CLAMP, 2" STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PS1100-2-SS EA 50

L0087-00

CLAMP, 2 1/2" STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PS1100-2-1/2-SS EA 50

L0088-00

CLAMP, 3" STAINLESS STEEL 316 | ALLIED TUBE & CONDUIT MODEL# PS1100-3-SS OR CALBRITE S63000SC00 EA 100

L0089-00

FUSE, 100AMP 600VAC NEMA 4X STAINLESS STEEL | DISCONNECT HEAVY DUTY, PART# H363SS EATON PART# DH363FWK EA 4

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16

COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0090-00

FUSE, 200AMP 600VAC NEMA 4X STAINLESL STEEL | DISCONNECT HEAVY DUTY, PART# H364SS EATON PART# DH364FWK EA 4

L0091-00

FUSE, 400AMP 600VAC NEMA 4X STAINLESS STEEL | DISCONNECT HEAVY DUTY, PART# H365SS EATON MODEL# DH365FWK EA 4

L0092-00

FUSE, 600AMP 600VAC NEMA 4X STAINLESS STEEL | DISCONNECT HEAVY DUTY, PART# H366SS EATON MODEL# DH366FWK EA 2

L0093-00 FUSE, 100AMP | LITTEL FUSE MODEL# FLRS100 EA 12

L0094-00 FUSE, 200AMP | LITTEL FUSE MODEL# FLSR200 EA 12

L0095-00 FUSE, 400AMP | LITTEL FUSE MODEL# FLSR400 EA 12

L0096-00 FUSE, 600AMP | LITTEL FUSE MODEL# FLSR600 EA 12

L0097-00 CONNECTOR # 4,2 PORT 600VAC | INSULATED, ILSCO MODEL# PBTS-2-4 EA 25

L0098-00 CONNECTOR # 1/0, 2 PORT 600VAC | INSULATED, ILSCO MODEL# PBTS-2-1/0 EA 25

L0099-00 CONNECTOR # 250kcm, 4 PORT 600VAC | INSULATED, ILSCO MODEL# PBTS-4-250 EA 25

L0100-00 CONNECTOR # 1/0, 3 PORT 600VAC | INSULATED, ILSCO MODEL# PBTS-3-1/0 EA 25

L0101-00 TAPE, 3/4" X 30' 600VAC 3M | INSULATION, SCOTT MODEL# 130C EA 30

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0102-00 TAPE, 1" X 30' 600VAC 3M | INSULATION, SCOT MODEL# 130C EA 30

L0103-00 TAPE, 1 1/2" X 30' 600VAC 3M | INSULATION, SCOTT MODEL# 130C EA 30

L0104-00 TAPE, 2" X 30' 600VAC 3M | INSULATION, SCOTT MODEL# 130C EA 30

L0105-00 TAPE, 3/4" X 60' 600VAC 3M | CAMBRIC, SCOTT MODEL# 2520 EA 30

L0107-00

SWITCH, 120V 300VAC | HOA N.O N.C. POS SIEMENS MODEL# 52PT6G2A ALLEN BRADLEY MODEL# 800T-J2A | SQUARE D MODEL EA 25

L0108-00

LED, RED 120V 300VAC 30.5MM | PILOT LIGHT, ALLEN BRADLEY MODEL# 800T-QH2R SIEMENS MODEL# 52PL4G2P | SQUARE D MODEL EA 20

L0109-00

LED, GREEN 120 12-120V 30.5MM | PILOT LIGHT, ALLEN BRADLEY MODEL# 800T-QH2G | SQUARE D MODEL EA 20

L0110-00

LED, YELLOW 120V 12-120V 30.5MM | PILOT LIGHT, ALLEN BRADLEY MODEL# 800T-QH2Y | SQUARE D MODEL EA 20

L0111-00

LED, BLUE 120V 12-120V 30.5MM | PILOT LIGHT, ALLEN BRADLEY MODEL# 800T-QH2B | SQUARE D MODEL EA 20

L0112-00

LED, AMBER 120V 12-120V 30.5MM | PILOT LIGHT, ALLEN BRADLEY MODEL# 800T-QH2A | SQUARE D MODEL EA 20

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0113-00

PUSH BUTTON, RESET 120V 300VAC | N.O. AND N.C., SIEMENS MODEL# 52PA8B2JP ALLEN BRADLEY MODEL# 800T-A2A | SQUARE D MODEL EA 30

L0114-00

PUSH BUTTON, RED 300VAC | AND LABEL, SIEMENS MODEL# 52PA8A3KP ALLEN BRADLEY MODEL# 800T-FX6A1 | SQUARE D MODEL EA 30

L0115-00

LABEL, EMERGENCY PUSH BUTTON | ALLEN BRADLEY MODEL# 800T-X504 | SQUARE D MODEL EA 30

L0116-00 CABLE, COPPER #8 THHN 600VAC BLACK | SOUTHWIRE MODEL# THHN8BLK FT 2,000

L0117-00 CABLE, COPPER #8 THHN 600VAC GREEN | SOUTHWIRE MODEL# THHN8GRN FT 1,000

L0118-00 CABLE, COPPER #3/0 THHN 600VAC BLK | SOUTHWIRE MODEL# THHN3/0BLK FT 1,000

L0119-00 CABLE, COPPER #4/0 THHN 600VAC BLK | SOUTHWIRE MODEL# THHN4/0BLK FT 500

L0120-00 CHARGER, BATTERY 6AMP 12VDC | MARINCO MODEL# CHARGE PRO 28106 EA 3

L0121-00

LED, SECURITY LIGHT GALVANIZED 4000WATTS | LUMENS-400, HONEYWELL MODEL#MA0201-17CR EA 20

L0122-00

FUSEHOLDER, 600VAC | THREE FUSES DIN RAIL MOUNT LITTEL FUSE MODEL# L60030C3PQDINR EA 40

L0123-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# B25 EA 50

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0124-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# B32 EA 50

L0125-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# B36 EA 50

L0126-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# B45 EA 50

L0127-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# B79 EA 50

L0128-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# CC112 EA 50

L0129-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# CC156 EA 50

L0130-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# CC103 EA 50

L0131-00

HEATER ELEMENT, FOR SQUARE D STARTERS 600VAC | OVERLOADS, SQUARE D MODEL# CC208 EA 50

L0132-00

POWER SUPPLY, 24VAC 120VAC | TELEMECANIQUE MODEL# ABL8RPS24030 OR AB1606XLP72E EA 3

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0133-00 REACTOR, 3 PHASE 600VAC | MTE MODEL# RL-08002 EA 3

L0134-00

ARRESTOR, SECONDARY SURGE 600VAC | SQUARE D MODEL# SDSA3650 EA 5

L0135-00

END CAPS, PLASTIC WHITE | FOR UNITSTRUT CHANNEL 1 5/8" X 1 5/8" PART# PS 61532 WHT EA 500

L0136-00

END CAPS, PLASTIC WHITE | FOR UNISTRUT CHANNEL 1 5/8" X 7/8 PART# PS 61532 WHT EA 500

L0137-00 DUCT, PVC 1" X 2" X 6' PANDUIT SLOTTED ADH | LIGHT GREY, PART# G1X2LG6-A FT 504

L0138-00 COVER, PANDUIT DUCT PVC 1"W X 6" | LIGHT GREY, PART# C1LG6 FT 504

L0141-00

ADAPTER, UBIQUITY POE 50V P/N# POE 50-60W EA

2

L0144-00

BALLAST, UNIVERSAL 120/277 PHILLIPS# ICN-2P32-N EA 2

L0146-00

BALLAST, UNIVERSAL 120/277 PHILLIPS ICN -4P32-N EA 2

L0148-00

BALLAST, T8 PART# SOP 2P59N35I EA 2

L0151-00

CONNECTOR, INSULATED 1/0 4 PORTILSO MODEL# PBTS-4 1/0 EA 20

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0153-00 CONNECTOR, INSULATED 250 KCM 2 PORTILSO# PBTS-2-250 EA 20

L0155-00 LIGHT, FLUORESCENT 32W SYLVANIA# F032-850-ECO EA 6

L0155-01 LIGHT, FLUORESCENT BULB P/N F096841XPECO EA 6

L0159-00

MODULE, 4 CHANNEL ANALOG INPUT #1769-IF4 EA 4

L0160-00 MODULE, 8 CHANNEL ANALOG INPUT P/N 1769-IF 8 EA 4

L0161-00 MODULE, IN/OUT P/N 1769-IQ6XOW4 EA 4

L0164-00 NANOSTATIOIN, UBIQUITY MS P/N NSM5US EA 4

L0167-00

PLC, COMPACT LOGIC P/N 1769-L32E BOX 4

L0170-00 VFD, LENZE A/C TECH MODEL# ESU 75 N 04TXB EA 2

L0172-00

SCOTCH SUPER 33 + GREEN; HIGH VOLTAGE TAPE 3M 7000006098 BOX 50

L0173-00

SCOTCH SUPER 33 + WHITE; HIGH VOLTAGE TAPE 3M 7000006097 BOX 50

L0174-00 SCOTCH SUPER 33 + RED; HIGH VOLTAGE TAPE 3M 7000006094 BOX 50

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

L0176-00 SCOTCH SUPER 33 + YELLOW; HIGH VOLTAGE TAPE 3M 7000006096 BOX 50

L0177-00 SCOTCH SUPER 33 + ORANGE; HIGH VOLTAGE TAPE 3M 7000031581 BOX 50

L0178-00 SCOTCH SUPER 33 + BROWN; HIGH VOLTAGE TAPE 3M 7000031580 BOX 50

L0179-00 SCOTCH SUPER 33 + GRAY; HIGH VOLTAGE TAPE 3M 7000006099 BOX 50

EMM QUARTZ CHICAGO TIME LAPSED METER T50A4 24VAC 50/60HZ MODEL #T50A4 EA 50

TRUMETER 722-004 ROHS 90-264VAC 50/60HZ MODEL #722-0004 EA 50

STEP DOWN TRANSFORMER .100KVA GENERAL ELECTRIC 120V PRI/24VAC SEC MODEL #9T58K2875 EA 10

STEP DOWN TRANSFORMER .100KVA GENERAL ELECTRIC 240-480V PRI./24VAC SEC MODEL #9T58K3027 EA 10

STEP DOWN TRANSFORMER .100KVA GENERAL ELECTRIC 240-480V PRI/120VAC SEC. MODEL #9T58K2804 EA 10

SIZE 0 SQUARE D 24VAC CONTROL COIL MODEL #8536SB02V01S EA 4

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

SIZE 1 SQUARE D 24VAC CONTROL COIL MODEL #8536SCO3V01S

SIZE 2 SQUARE D 24VAC CONTROL COIL MODEL #8536SDO1V01S EA 12

SIZE 3 SQUARE D 24VAC CONTROL COIL MODEL #8536SEO1V01S EA 4

PILOT LIGHTS LED RED 24VAC POWER MODEL #CSW30SD1E26 EA 20

PILOT LIGHT LED BLUE 24VAC POWER MODEL #CSW30SD4E26 EA 20

PILOT LIGHT LED YELLOW 24VAC POWER MODEL #CSW30SD3E26 EA 20

PILOT LIGHT LED WHITE 24VAC POWER MODEL #CSW30SD0E26 EA 20

CONTROL RELAY 8 PINS 24VAC COIL POWER MODEL #R15-2012-23-5024-WTL EA 100

CONTROL RELAY 11 PINS 24VAC COIL POWER MODEL #R15-2013-23-5024-WTL EA 100

CONTROL RELAY 8 PINS 24VDC COIL POWER MODEL #R15-2012-23-1024-WTL EA 20

CONTROL RELAY 11 PINS 24VAC COIL POWER MODEL #R15-2013-23-1024-WTL EA 20

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COMMODITY DESCRIPTION U/M QTY UNIT PRICE TOTAL COST BRAND NAME & MANUFACTURER # LEAD TIME

9998S01 NORMALLY CLOSE CONTACT MODULE SQUARE D EA 20

9999SX6 NORMALLY OPEN INTERLOCK SIZE 0-7 SQUARE D EA 20

PLUG IN TIMER ON DELAY 8 PINS 24VAC SQUARE D 0.6-60 SEC. 9050JCK13V14 EA 10

PLUG IN TIMER ON DELAY 8 PINS 120VAC SQUARE D 0.6-60 SEC. 9050JCK13V20 EA 10

PLUG IN TIMER ON DELAY 8 PINS 24VAC SQUARE D 0.1-10MIN 9050JCK16V14 EA 10

PLUG IN TIMER ON DELAY 8 PINS 120VAC SQUARE D 0.1-10MIN 9050JCK16V20 EA 10

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Special Instructions: Material will be ordered as needed and be billed as such. The Purchase Order quantities are subject to BPUB’s right to increase or decrease as deemed necessary. Stipulate below, if an increase or decrease in quantities affects bid price: Quantities are estimates based on prior year usage history.

(_____) Yes, an increase or decrease in quantities affects bid price (_____) No, an increase or decrease in quantities will not affect bid price.

Company Name: Company Address:

Authorized Company Representative: (Print) Authorized Company Representative: Signature – Failure to manually sign bid will disqualify it

Telephone #: Fax #: Email: _____________________________________________________________

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REQUIRED FORMS CHECKLIST The following forms are to be submitted as a part of the Bid/RFP/RFQ document: NAME FORM DESCRIPTION SUBMITTED WITH BID

YES NO Legal Notice

Acknowledgement Form

Debarment Certification

Ethics Statement

Conflict of Interest Questionnaire

W9 or W8 Form

Direct Deposit Form

Residence Certification Form

Special Instructions

Bid Schedule/Cost sheet completed and signed

Cashier Check or Bid Bond of 5% of Total Amount of Bid (if applicable)

OSHA 300 Log (if applicable)

Contractor Pre-Bid Disclosure completed, signed and notarized (if applicable)

Sub-Contractor Pre-Bid Disclosure completed, signed, and notarized (if applicable)

References Complete the Previous Customer Reference Worksheet for each reference provided

Addenda

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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS (Complete and Return this form with Proposal) Name of Entity:____________________________________________________ The prospective participant certifies to the best of their knowledge and belief that they and their principals: Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency: Have not within a three year period preceding this proposal been convicted of, had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, Local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, Local) terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 USC Section 1001, a false statement may result in a fine up to $10,000.00 or imprisonment for up to five (5) years, or both. ____________________________________________ Name and Title of Authorized Representative (Typed) _____________________________________________ _________________ Signature of Authorized Representative Date I am unable to certify to the above statements. My explanation is attached.

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ETHICS STATEMENT (Complete and Return this form with Proposal) The undersigned Firm, by signing and executing this proposal, certifies and represents to the Brownsville Public Utilities Board that Firm has not offered, conferred or agreed to confer any pecuniary benefit, as defined by (1.07 (a) (6) of the Texas Penal Code, or any other thing of value as consideration for the receipt of information or any special treatment of advantage relating to this proposal; the Firm also certifies and represents that they have not offered, conferred or agreed to confer any pecuniary benefit or other thing of value as consideration for the recipient’s decision, opinion, recommendation, vote or other exercise of discretion concerning this proposal, the Firm certifies and represents that they have neither coerced nor attempted to influence the exercise of discretion by any officer, trustee, agent or employee of the Brownsville Public Utilities Board concerning this proposal on the basis of any consideration not authorized by law; the Firm also certifies and represents that they have not received any information not available to other Firms so as to give the undersigned a preferential advantage with respect to this proposal; the Firm further certifies and represents that they have not violated any state, federal, or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that Firm will not in the future offer, confer, or agree to confer any pecuniary benefit or other thing of value of any officer, trustee, agent or employee of the Brownsville Public Utilities Board in return for the person having exercised their person’s official discretion, power or duty with respect to this proposal; the Firm certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of the Brownsville Public Utilities Board in connection with information regarding this proposal, the submission of this proposal, the award of this proposal or the performance, delivery or sale pursuant to this proposal.

THE FIRM SHALL DEFEND, INDEMNIFY, AND HOLD HARMLESS THE BROWNSVILLE PUBLIC UTILITIES BOARD, ALL OF ITS OFFICERS, AGENTS AND EMPLOYEES FROM AND AGAINST ALL CLAIMS, ACTIONS, SUITS, DEMANDS, PROCEEDING, COSTS, DAMAGES, AND LIABILITIES, ARISING OUT OF, CONNECTED WITH, OR RESULTING FROM ANY NEGLIGENT ACTS OR OMISSIONS OF CONTRACTOR OR ANY AGENT, EMPLOYEE, SUBCONTRACTOR, OR SUPPLIER OF CONTRACTOR IN THE EXECUTION OR PERFORMANCE OF THIS PROPOSAL.

I have read all of the specifications and general proposal requirements and do hereby certify that all items submitted meet specifications. COMPANY: _______________________________________ AGENT NAME: ____________________________________ AGENT SIGNATURE:________________________________ ADDRESS:_________________________________________ CITY: _____________________________________________ STATE: _____________________________ ZIP CODE: ________________ TELEPHONE: ________________________ TELEFAX: ___________________ FEDERAL ID#:_____________________AND/OR SOCIAL SECURITY #: ________________

DEVIATIONS FROM SPECIFICATIONS IF ANY: NOTE: QUESTIONS AND CONCERNS FROM PROSPECTIVE CONTRACTORS SHOULD BE RAISED WITH OWNER AND ITS CONSULTANT (IF APPLICABLE) AND RESOLVED IF POSSIBLE, PRIOR TO THE BID SUBMITTAL DATE. ANY LISTED DEVIATIONS IN A FINALLY SUBMITTED BID MAY ALLOW THE OWNER TO REJECT A BID AS NON-RESPONSIVE.

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(THIS FORM MUST BE COMPLETED IN ITS ENTIRETY AND SUBMITTED WITH BID RESPONSE)

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BROWNSVILLE PUBLIC UTILITIES BOARD

RESIDENCE CERTIFICATION

In accordance with Art. 601g, as passed by the 1985 Texas Legislature, the following will apply. The pertinent portion of the Act has been extracted and is as follows: Section 1. (a)

(1) "Nonresident bidder" means a bidder whose principal place of business is not in this state, but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in this state.

(2) "Texas resident bidder " means a bidder whose principal place of business is in this state, and includes a contractor whose ultimate parent company or majority owner has its principal place of business in this state.

Section 1. (b)

The state or governmental agency of the state may not award a contract for general construction, improvements, services, or public works projects or purchases of supplies, materials or equipment to a nonresident bidder unless the nonresident's bid is lower than the lowest bid submitted by a responsible Texas resident bidder by the same amount that a Texas resident bidder would be required to underbid a nonresident bidder to obtain a comparable contract in the state in which the nonresident's principal place of business is located.

I certify that _________________________________________________________ (Company Name) is a resident Texas bidder as defined in Art. 601g. Signature: _____________________________________________________________ Print Name: I certify that_______________________________________________________________ (Company Name) is a nonresident bidder as defined in Art. 601g. and our principal place of business is: _

(City and State) Signature: Print Name:

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Previous Customer Reference Worksheet

Name of Customer: Customer Contact:

Customer Address: Customer Phone Number:

Customer Email:

Name of Company Performing Referenced Work:

Provide a brief description of the work performed for this customer (add additional page if required)

What was the Period of Performance? What was the Final Acceptance Date? From: To:

Dollar Value of Contract? $____________________

What Type of Contract? Firm Fixed Price Time and Material Not to Exceed Cost Plus Fixed Fee Other, Specify:______________________