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Prescribed by Stale boartl of Accounts Boyce Forms • Sy5lems, Muncie, IN 1240
CONTRACTORS BID FOR PUBLIC WORKS
PART I
(To be completed for III bids)
(Please type or paint)
Date: ~ ~' ~ ~ r ~-CX.7~
1. Governmental Unit (Owner):
2. County:
3. Bidder (Firm): ~~r.S'fuc~t~-- `~~VC.~~ ~~65 ~NL
Address: ~~3 ~'R~X-~b2S T~V~
City/State: t2 ttiV~6
4. Telephone Number: S~O~-o~~3-~(~p'"Z xaa4
5. Agent of Bidder (if applicable):
Form Na. 96 (Revised 2000)
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of
(Governmental Unit) in accordance with plans and specifications prepared by
and dated for the sum of
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 additional units of material included in the contract are needed, the cost of 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, coldr, 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) ;
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. I heGeby certify that I and all subcontractors employed
by me for this project will use U.S. steel products on this project it' awarded. I understand that violations hereunder
may result in forfeiture of contractual payments. '
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement ~s mandatory. Any bid submitted without said financial statement as
required by statute shall thereby be rendered invalid. The financial statement provieded hereunder to the governing
body awarding the contract must be specific enough in detail so that said governing body can make a proper
determination of the bidder's capability for completing the project if awarded.
SECTION I~ OATH AND AFFIRMATION
I hereby affirm under the penalties of perjj~ry 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 this _~~ day of V Uw1s ,
By ~ /~~ (Name of Organization)
y~/'' ..~
of Person Signing)
ACNCNOWLEDGEMENT
STATE OF T/J ~
COUNTY OF Cj-LA-/L,J~ '~
~ ~ rn C ~ /~~ ' /~3c~k~ .- being duly sworn, deposes and says that he is
~~ ~".^~ c. M,4rur~--(x~/Z of the above _ ~~ TL~C.fe y ~~ ~c_c_lC ~,~-~ S
(Title) ~ ..ZtiC ,
and that the answers to the questions in the tore oin (Name of Orgarnzation)
g g questionnaires and all statements therein contained are
true and correct.
Subscribed and sworn to before me this ~__
day of _ :J rt w ~ ayU,9
My Commission Expires: __ r~ ~ f /7
County of Residence: ~~ Y .U
Public