HomeMy WebLinkAbout05) Bid of American Contracting
,~
f~rm No. 95 (Revised 1997)
BID OF
American Contracting & Services, Inc.
(Contractor)
6200 E. Highway 62, Suite 200
(Address)
Jeffersonvi~le, IN 47130
FOR
PUBLIC WORKS PROJECTS
OF
('\1..
Bonenberger's Oak Grove Subdivision
Drainage Project
City of Jeffersonville, Indiana
Filed
December 22, 2003
, 19
Action taken
B-102
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Prescribed by the State Board of Accounts
Form No. 96 (Revised 2000)
I
coNtRActORS BID fORP(JSUC'NORKS
PART I
(To be completed for all bids)
Date: December 22, 2003
1. Governmental Unit (Owner):
City of Jeffersonville
2. County:
Clark
3. Bidder (Firm):
American Contracting & Services, Inc.
Address:
6200 E. Highway 62, Suite 200
City/State:
Jeffersonville, IN 47130
4. Telephone Number:
(812) 280-4404
5. Agent of Bidder (if applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
roo" the public works project of Bonenberger's Oak Grove Subdivision Drainage Proj ect, Job No. 9705A
(Governmental Unit) in accordance with plans and specifications prepared by
& se:Vi~. c - and <laled . 12/22/03
~~j:~~~~~~
American Contracting
for the sum of
,.
$ /. 4S".37S 1,,3-
I . I
The undersigned further agrees to furnish a bond. or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
, If additonal units of material included in the. contract are needed, the cost of the units must be the same as
that shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or
indirectly related to employment because of race, religion. color, sex, national origin or ancestry. Breach of this
covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(if applicable)
r
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States. I.C. 5-16-8-2. 1 hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of con.tractual payments.
B-I03
,
NON-COLLUSION AFFIDAVIT
{\ The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or . agel1t .()f tlie firm, cOm pan)!, . corporatioi1()f partnership represented by hiin, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to .ind!Jce anyone to refrain from bidding, and that this bid is
made without reference to any other bid and without any agreement, understanding or combinaton with any other
person in reference to such bidding.
_, He further says that no person or persons, firms, or corporation has,. have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such contract.
OATH AND AFFIRMATION
I affirm under the penalties of perjury that the foregoing facts and information are true and correct to the
best of my knowledge and belief.
Dated at Clark County
this ~d day of December, 2003
, tOOt.
American Contracting & Services, Inc.
~~~
Michael D. Hublar, Chief Highway Engineer
(Title of Person Signing)
{\
ACKNOWLEDGMENT
STATE OF
INDIANA
)
) SS:
)
COUNTY OF Clark
Chief Highway Engineer
(Title)
being duly sworn, deposes and says that he is
American Contracting &
of the above Services, Inc. and
(Name of Organization)
Michael D. Hublar
that the statements contained in the foregoing bid, certification and affidavit are true and correct.
Subscribed and sworn to before me this
22nd
1fJrJt
sf';'\-,
My Commission Expires:
8-12-06
, r\ i County of Residence:
Washington
r\
ACCEPTANCE
The above bid is accepted this .~.daYOf ,ltUil/lth(
conditions:
Zt:ZJ4- , subject to the. following
...
PART II
(Complete sections \, II, III and IV for all state and local public works projects as required
by statutes if project is one hundred thousand dollars ($100,000) or more. (IC 36-1-12-4)
Governmental Unit: City of jeffersonville
Bidder (Firm): American Contracting & Services, rnc.
Date: 12/22/03
These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional
pages for each section as needed.
(\ I SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1) year prior to the date of
the current bid?
Contract Class of Work When Name and Address of Owner
Amount Completed
See Attached
2. What public works projects are DOW in process of construction by your organization?
Contract Class of Work When to be Name and Address of Owner
Amount completed
See Attached
r-'\I B-104
('
I
3. Have you ever failed to complete any work awarded to you?
No
If so, where and why?
4. List references from private firms for which you have performed work.
__.Bravura - Dan DeYoung
AquaSource - Steve Tolliver
Waterfront Development - Gary Pepper
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you
could begin work, complete the project, number of workers, etc. and any other information which you believe
would enable the governmental unit to consider your bid.) _ _A ~ ~
-'JdLl14~-~LJ tq. ~~:.v ~~~, "
'~tI~ I '!# t/Jl ~ 'a ~.;C ~ ( l U-::>~.
2. If you intend to sublet any porton of the work, state the name and address of each subcontractor, equipment
to be used by the subcontractor, and whether you expect to require a bond. However, if you are unable to
currently provide a listing, please understand, a listing must be provided prior to contract approval.
lJdl....'L ~.' '. /;~~~ ~/~.L~ J .~~. LJ~
.~~~/: i t<r u
3. What equipment do you have available to use for the proposed project? Any equipment to be used by
~contractors may. ~ allssoo b Dee r r5eUl uirreeld to be listed by the governmental un. it. -+- .~" ~. .
~~~ ~ ~~ Ii ~p ~~ 7--
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4. Have you enter~d 11,to contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices
listed.
tr..
B-I04
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SECTION III CONTRACTOR'S FINANCIAL STATEMENT .
~, :
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Attachment of bidder's financial statement ismandatbry. Any bidsubrnittedwithbut saidfinaricial statement
as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the
governing body awarding the contract must be specific;:.ef1Pugh in detail so that said governing body can make a
proper determination of the bidder's capability for completing the project if awarded.
SECTION IV OATH AND AFF1RMA TION
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for
public works are true and ,correct to the best of my knowledge and belief.
Dated at
Clark County
this 22nd day of ' December, 2003
, I2JJIJI2.
American Contracting & Services,
~ (Name of Organization)
B~ . ~r;)l--tl~
Michael D. Hubla~~ Chief Highway
{Title of Person Signing)
Inc.
67. ·
~~
Engineer
ACKNOWLEDGMENT
STATE OF
INDIANA
)
) SS:
r\
COUNTY OF Clark
Miehael n. ' Hublar
being duly sworn, deposes and says that he is
American Contracting
of the above & Services, Tnc. and
(Name of Organization)
Chief Highway Engineer
(Title)
that the statements contained in the foregoing bid, certification and affidavit are true and correct.
Subscribed and sworn to before me this
22nd
/zoob.!
~
My Commission Expires:
8-12-06
County of Residence:
Washington
B-I05
.,
,
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12.0 BID FORMS
NOTE:
INSERT AND ATTACH TO FORM 96, DO NOT USE THE
CONTRACTOR'S BID SECTION ON FORM 96. BE SURE TO SIGN
BID, NOTARIZE BID AND EXECUTE NON-COLLUSION
AFFIDAVIT.
CONTRACTOR'S BID FORM
.J
JEFFERSONVILLE DRAINAGE BOARD .
4TH FLOOR, CITY-COUNTY BUILDING
501 EAST COURT AVENUE
JEFFERSONVILLE, INDIANA 47130
"1
'.
'1:
RE: BONENBERGER'S OAK GROVE SUBDIVISION DRAINAGE PROJECT
JOB NO. 9705A
.:.;
Gentlemen:
.r
We submit, herewith, our sealed proposal to furnish all necessary labor, material and
equipment to construct the above captioned project, in accordance with the subject plans and
specifications at the unit prices listed herein.
American Contracting hereby acknowledges the following addendums:
,J
Addendum 1:
Addendum 2:
Addendum 3:
December 16, 2003
December 18, 2003
December 18, 2003
t ~~01--
Jennifer C. Lawson
My CiOmL:1ission Expires:
8-12-06
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A-205
BONENBERGER'S OAK GROVE SUBlHVISION
DRAINAGE PROJECT JOB NO. 9705A
._-----------------------~-----------------~----------------------------------------------------
ITEM APPROXIMATE DESCRIPTION WITH UNIT PRICE TOTAL AMT.
NO. QUANTITY UNIT PRICE IN FOR BID
WRITTEN IN WORDS NUMBERS ITEM
.-----------------------------------------------------------------------------------------------
1
o TONS
Crushed Limestone
~~~7'u~~
4:.......If::-:?...................l)ollars
Per Ton
$
~.Q
~~-
$
o
.----------------------------------------------------------------------------------------------
2
o TONS
Bank~~n_~d ~
FJrz;~...:~.......m....-..... .
.._._........4:..~Dollars
Per Ton
$
.:::> <:>
~;;;>- - $
o
.-----------------------------------------~----------------------------------------------------
3
OCY
Formed Concrete
~~~/~m..
.t..~~-:'::___._......._:::__Dollars
Per Cubic Yard
~'?
$ ~ec. - $
o
,----------------------------------------------------------------------------------------------
~,... f
4 0 CY Non-Formed Concrete
N~lor~L
~~/......._.........=........._._._...
........./(~.'::;:'................... Dollars t~;::>
._______________________________~~!_s:~~~~_~_~~_______________!__~~?_~_~____~_____9________
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',-'11
5
o LBS
Reinforcing Steel
Fo~~__..4.................._._..... .
f->~/ -
......z!-.:~~..m..m_.......... Dollars
Per Pound $ d-:io>""O
$
o
.----------------------------------------------------------------------------------------------
6
o SY
~~~~.t.mmm.
....~f..~~.......m.n Dollars
Per Square Yard
$
,;>;;:.
6-
$
o
~,;;'.j
'-":1
1
.----------------------------------------------------------------------------------------------
~,..J
Ty~ 'If M. anh9le
~1fJJ.. U~
_ ... .ui~...m................-.-,
p;~u :h.3.f=::-DOllars $ /7SD ~ $ /3 b6b <::? /
.------------------------------------------------------------------r-----------------?---------
8 1 EA MH~$~JU 'rJd::
. for:~~............~/.-........T..~ J
~4.f:Lf.~ollars' .,/... -,>.:> ; 1.0:;;:' .
Per Each $ q-i'oo. - $ ~ '8QC. -
.____________------------------------------------------------------~------------------f--------
7
7EA
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BONENBERGER'S OAK GROVE SUBDIVISION
DRAINAGE PROJECT JOB NO. 9705A
.-----------------------------------------------------------------------------------------------
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ITEM APPROXIMATE DESCRIPTION WITH UNIT PRICE TOTAL AMT.
NO. QUANTITY UNIT PRICE IN FOR BID
WRITTEN IN WORDS' NUMBERS ITEM
.-----------------------------------------------------------------------------------------------
9 20 EA Adjust Manhole Casting to
Grade
FoI1f;r-:.~D....ml.l..... ..
, ....::t:'..m7Lf.~............. 0 ars . ~.:> 0':)
Per Each $ ""00 - $ b bOO - /
.___~-------------------------------------------------------------~-----------------r---------
10 1656.90 LF ~;:~a:;~~ ,/
...!.-:!}L~............~.. Dollars . 0.0 $'7.:-
Per Linear. Foot $ . J S; -- $ 1 t/ 5"(; 0 -
,__________________________ ________________________________________'=t:-_____________ --7--------
11 32W LF ~~~r,t.. . .
.' ......../I.~...................m Dollars ',rD:> 'ZO
,_______________________________~~!_~~~':~~~~!__________~____~___~~_=_______~_i~-~22- - ~
12 39 EA 6" Property Service
Connection Pipe with
Cl~ant~t, ~',
FoVf~...m=............lM
....~....:.:I.{~.=......... Dollars o~ ..).:.:;) /
, Per Each . $1,35'0 - $ b-Z-6~-'
.-----------------------------------------~---------------------- 1--------------------~------
13 2 EA Connect 12" Diameter Pipe
to an Existing Structure
FO~~~.,..
~~..i{1.:..../.(.~~ollars c~ <(;>.,:)
._______________________________~~!____~_~------------________~__~~-~~~-~----~--~~~~-~-J ~
14 2 EA Connect 24" Diameter Pipe
i~~~~~~..,.~-
~......... ..L.~ol1ars J./ 0 ? . ~ /
._______________________________~~!_~~~~_~------------________~_~~:z-~--~--~--~~~~-~
15 1 EA Connect 8" Diameter Pipe
~o~~e~-
e.f...../t~ohars ~ D:> //
,________________________________~!_~~~~__---.:---------________~__41?::.~-~~---~---4-'-t?:~- .-
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BONENBERGER'S OAK GROVE SUBDIVISION
DRAINAGE PROJECT JOB NO. 970SA
.-----------------------------------------------------------------------------------------------
I
ITEM APPROXIMATE DESCRI~TION WITH
NO. QUANTITY UNIT PRICE
WRITTEN IN WORDS
UNIT PRICE
IN
NUMBERS
TOTAL AMT.
FOR BID
, ITEM
.-----------------------------------------------------------------------------------------------
. '
16 1 EA Connect 6" Diameter Pipe .
;~~".~~~~ -
_____________________________~~~i~~=::~::_____~J,J~2:~~-~---J.-~~~ r
17 . 19EA CatchBas~~ .
For.~..................................
.....4.....LL~.......~ Dollars ,/
Per Each $ J lX;A/o $ I i {)CD ~ -> /
.------------------~----------------------------------------------J1-----------------,---------
18 29 EA ' , ;~~;~~~.~
, ......~....A:~~.... Dof(~~ q , ~ Q.~/
Per Each $ J DSD - $ $0 t/sa ~
"---------------------~----------------~---~-----~---------------~--------------------l-------
19 5 EA ~;~~~k'1
, .~...../z~............. Dollars , t;:>> -:;J c~ '
Per Each . $ J 0 ~ - $ S;l-.:SO - '/
.------------------------------------------~---------------------~-----------------t---------
20 8EA ~~~~
....4......./L.~.............. Dollars " ..;;> ,>
"_______________________________~~!_~~~~______________--------~--42~=----~--lQ7!i.~-Q~~ /
21 1 EA ~~~~ a~ -=
Per Each "$ 2~- $ ~~-3/
,------------------------------------------------------------------T---------------~r--------
22 1 EA ~;~~U7
P~;..E~~.~Ollars $ I ~Q ~ $ I.- ~D ~/
,_________________________________________~-----------------------~~--------------t~--------
23 ,1 EA Specia CB 3A .
. For. .............. ..... ......... ....~ /
.~"\::'
....... 1........ ..1..~Dollars . _ O? , <.>--..:> "
Per Each - - ", $ 3:3::D- $ J 3~"""
"_______________________~-----------------~-----------______________y________________r_________
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BONENBERGER'S OAK GROVE SUBDIVISION
r\ I DRAINAGE PROJECT JOB NO. 9705A
._-----------------------------------------~----------------------------------------------------
ITEM APPROXIMATE DESCRIPTION WITH UNIT PRICE TOTAL AMT.
NO. "QUANTITY UNIT PRICE IN FOR BID
WRITTEN IN WORDS, NUMBERS ITEM
.~
"
j
,,!
J
.-----------------------------------------------------------------------------------------------
~~FrI.~~~......~~t~~:~~~~
~
...... ......... ....~Dollars ~~ .,;)~ .--
Per Each $ :J J DD - $ .:; 3~~ _.
._____________________________________________________-------------r----------------J----------
25 8EA 12':~tal~
. For..L~..............-...................
.....4..~2{~_.........::_Dollars ;> ~.~ //
" ....- 'J::;)
Per Each $ ~ - $ / h:::>::. '~
._____________________________________________________------------------------------7----------
26 1 EA~F18~~t~ _ .
............4.....Lk~~Dollars t>O . /
.' Jj~6 -- 0.0
Per Each . $ cT cr: $ ;~S--
.-----------------------------------------~-----------------------------------------~--------
27 1 EA 36" Meta:J,:nd Section
For~....~~~7:h.A,...~..
p~~t:~...........::- Dollars
24
1 EA
.,:) :>
$b(:)O-
<;;).c;;;> /
,",00 - ./
$
.----------------------------------------------------------------------------------------------
28 2215.73 LF 12" Reinforced Concrete
~~~"~f)t.'.~ mtmm
~ . '
________________________------_~~L!~~~~~L-~-~~~~:::---__!_,JQ~------U~!:;_~U, ,,:/
29 2247.25 LF 15" Reinforced Concrete
~~~3~..~..4....
......~.zr;:!:............l)ollars ?'>.F'> - /
~..--, ~ '>-J
Per Linear Foot . $ "J 7- - $ 1 L 'il J-. -
.----.---------------------------------------------------------------------------------7-- -----
30 1620.49 LF 18" Reinforced Concrete
~:~_=~m . . /.'
..I:..~IL~.~...........Dollars ~ a ~ $' 3 ~ '"j 1 t /' .
_______________________________~~:_~i!:~~~~~!_______________~______1_::_________~____~-~-'1 --
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BONENBERGER'S OAK GROVE SUBDIVISION
DRAINAGE PROJECT JOB NO. 9705A
._-----------------------------------------~----------------------------------------------------
ITEM APPROXIMATE DESCRIPTION WITH UNIT PRICE TOTAL AMT.
NO. QUANTITY UNIT PRICE IN FOR BID
WRITTEN IN WORDS NUMBERS ITEM
(\
31
358.43 LF
.-----------------------------------------------------------------------------------------------
24" Reinforced Concrete
Piperf;~s 3
FQr......~;y:a.=...~............
p;'i~~' Dollars $ 4-;)'~::> $ 5' D~.f-. D~ ~
.---------------------------------------------------------------------------------,------------
, .' .
32 40 LF 36" Reinforced Concrete
~~w#..
. .__.........L.~................... Dollars ,. ~ . '/
. Per Linear Foot $ to -g ... -- $ 2- I '--l c ..:~->
.-----------------------------------------~~----------~--~----------------------------t--------
33 193 LF Mil12" Deep and 2' Wide for
Pavi!.lg ~
FO~~~.........................
.........:z,__~.............__. Dollars ~ (>0 00 /
._______________________________~~!_~~c:':~~~~~_______________~___~__:::.______~____~1_1:.___:: .
34 20,073 LF 2' Concrete Curb. and Gutter
For....~t.:-*....1:..................
.--...~Lt~.......: Dollars . o~ "" 0 /
Per Linear Foot . $ l' - $ I 100 .5 g'-f 0;..;1....:
.----------------~-----------------------------------------------------------------------r-----
35 1,482 TONS INDOT Asphalt Surface
~~.~d!4_~~~~~.s
p~uT~d~DOllars $ cf'-f.~~ $ 105 Zo'X "'.;.,'="/
'---~-------------------------------------~-------------------------------------------~-------
36 4,446 TONS INDOT Base Asphalt
Intermediate No. 8 for
~~~~~~m /.,
...t...~~.~.............. Dollars ~ ~'D
Per Ton $:.16 - $ LIo6 ()5~ -
,-------------------------------~---------~--------------------------------------- -----1------
37 12,730 TONS INDOT DGA Type '0',
~.~D..~Y-l.1:...... .. . /
...........L.!-::.................... 0 ars ,~O .;>=
Per Ton $ I" ~ $ dt>3' ~~ -
.-----------------------------------------T----------~----------~-------~~----~--------~jL----~
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BONENBERGER'S OAK GROVE SUBDIVISION
DRAINAGE PROJECT
JOB NO. 9705A
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.-----------------------------------------------------------------------------------------------
ITEM APPROXIMATE
NO. QUANTITY
DESCRI~TION WITH
UNIT PRICE
WRITTEN IN WORDS
UNIT PRICE
IN
NUMBERS
TOTAL AMT.
FOR BID
ITEl\1
._-----------------------------------------~----------------------------------------------------
"."\
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38 10,775 GALS INDOT Prime Coat
FGb.~.....~.............. _
..........[...L..................... Dollars ~ -, , SV /
. Per Gallon $ b -- $.s; :2 ~1 --
._----------------------------------------~------------------------------------------~---------
39 1,347 GALS INDOT Tack C:oat
For...TPJ,~..f.......................
......:~L.;,~......... Dollars ()O ,'" 00. /
Per Gallon $ I.,.; $ L 'J 4:L -.
._----------------------------------------~----------------------------------------- ,---------
40 4,777 SYS Gravel Driveway
Repl~ ~
_______________________________;;if~~i~i~-~~~=----_~___1_~::______~__;i~-Y-?{i ~ /
41 2,580 SYS Asphalt Driveway
Replacement ~
For.~~.:.......~~~...
p~"s'~~~~" Dollars $ d-~ ~ $ ~ 1 3 t-lo. ~ /
.-----------------------------------------~---------------------------------------------r------
42 645 SYS Concrete Driveway
~;~~:~-- .
............Z1:................... Dollars ..;>.0 M'~ /
Per Square Yard $ 4;)- - $ d-<f} D~~ -'
._----------------------------------------1-------------------------~--:--------------~---- --
43 10,432 LF ~~~::::~
...1lP.........I.i.~.........: Dollars .' '::>0 . '. .' ~ /
Per Linear Foot $ Z~9-- $ :;;2..,50 )''8 -
._---------------------~------------------------------------------------------------------~ --
44 3 EA Lower Existing Sanitary
Sewer Lateral 18" to Avoid
the Proposed Storm Sewer
For'~"~M /
p~~~<==-f)Ol1!rrs $ tfSt. ~ $ I ~~ ~" .
._----------------------------------------~------------------------------------------~---------
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BONENBERGER'S OAK GROVE SUBDIVISION
DRAINAGE PROJECT JOB NO. 970SA
._----------------~--------------~---------~----------------------------------------------------
I
ITEM APPROXIMATE DESCRIPTION WITH UNIT PRICE TOTAL AMT.
NO. QUANTITY UNIT PRICE IN FOR BID
WRITTEN IN WORDS NUMBERS ITEM
.-----------------------------------------------------------------------------------------------
A1te~H7 A L~,Jl
FO~..m.......................
...m._...........Lt.~Dollars. 0:> 0.0 /"
Per Each $ L l~- $ j l~-
___________________________________________~-----------------------~-------------- t---------
46 48 LF Heavy Galvanized Chain,
;~~~.~...f}........................
.....?:!2i.f!::-::............= Dollars
Per Linear Foot
45
1 EA
I E>~~
$ b -
$ j.~~~ /
.----------------------------------------------------------------------------------------------
47 4 EA Power Pole Posts, Min. 8"
Diameter by 7' Long,
Drilled and Installed "
ForT~~..~
. P~;&~h= Dollars $ ~ ~o $ L Doc ~~ /
___________________________________________,__________-------------------------------t---------
48 4.53 ACRES Seed, Fertilize and Mulch
~~~~- . /
~A~~--....~~ollars $ l tf~:> $ l4~~~
___________________________________________~~----,--~-______________~----------------J---------
~:'~:}
Silt Fence, Insfled
L),r '
. F04-d~''''..'' ................---..... /
.....m...E.L~..,.....---...... f1011ars ~ ~~
Per Linear Foot $ I __ $ l ~:.>D .....
___________________________________________,_7________-------------------------------~---------. ~
TOTAL BID PRICE FOR ITEMS 1 THRU49 = . $/1 tf;/f4}1,i,'r~
49
1,000 LF
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BID FOR:
BONENBERGER'S OAK GROVE
SUBDIVISION DRAINAGE PROJECT
JOB NO. 9705A
CITY OF JEFFERSONVILLE
CLARK COUNTY, INDIANA
RESPECTFULLY SUBMITTED,
......p..~.c::~.~.I?~.!... .?~.~....~.9.Q}.... ............ .......... ........................ ..........
DATE
C :ISydneylwpd",,1919705197050 "ecHon 02. "'I'd
A-213
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TO THE BIDDER -
The following Form 96a is not required by the State Board of Accounts. However, the bidder
must either use this form or one similar tp it prepared by their accountant.
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JACOBI, TOOMBS AND LANZ, INC.
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