HomeMy WebLinkAboutExhibit10t� UU1
Certification Statement
Please quote on this form, if applicable, net prices for the item(s) listed. Return signed original and
retain a copy for your files. Prices should include all costs, including transportation to destination.
The City reserves the right to accept or reject all or any part of this submission. Prices should be
firm for a minimum of 120 days following the time set for closing of the submissions.
In the event of errors in extension of totals, the unit prices shall govern in determining the quoted
prices.
We (I) certify that we have read your solicitation, completed the necessary documents, and propose
to furnish and deliver, F.O.B. DESTINATION, the items or services specified herein.
The undersigned hereby certifies that neither the contractual party nor any of its principal owners or
personnel have been convicted of any of the violations, or debarred or suspended as set in section
18-107 or Ordinance No. 12271.
All exceptions to this submission have been documented in the section below (refer to paragraph
and section).
EXCEPTIONS:
PING ‘5'ec a"r, excep ons
in OPE-KIS re51ofSe ,n eIcc-fro nIC
I-8)
(Seeders
We (I) certify that any and all information contained in this submission is true; and we (I) further
certify that this submission is made without prior understanding, agreement, or connection with any
corporation, firm, or person submitting a submission for the same materials, supplies, equipment, or
service, and is in all respects fair and without collusion or fraud. We (I) agree to abide by all terms
and conditions of this solicitation and certify that I am authorized to sign this submission for the
submitter. Please print the following and sign your name:
SUPPLIER NAME: _. 0 PE ' n C
ADDRESS:
1la83 E-4SJc View 31vd - Sviic lid
PHONE: 65/"0?3(-(-0100 .FAX r s-i-aaY-037-3
EMAIL: M d0kovr LL Q S44-1- Pcd . CoM .PER:
SIGNED BY:
TITLE: Pi es\dtoa+ DATE• f 11ai'/Q7
F.1ILURE ) COMPLETE. SIGN. AND RFTI .RN THIS FORM SHALL DISQUALIFY THIS BID,
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