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bID, OFFER OR PROPOSAL FOR SALE OR LEASE OF MATERIALS
(Defined at I.C. 36-1-2-9.5)
(Please type or print)
Date: _ ~ _l~-~c~
1. Governmental Unit: r ~ ~ ~Rw~~'i `~~fl
2. County: - ~~
3. Bidder (Firm): /'~ ~'/U~~~`,', ~ ~~ ~ ~ ~-`'"~C '
Address: ,l~~~l~ ~~~ ~ ~jjry~ ~ ~ ~~~°
City/State: ~e-~-~+~-J c%h ~l ~ l~ i ~~ ~"7f ~ ,~~
4. Telephone Number: ~ ~ - -a'v-~
5. Agent of Bidder (if applicable): ~ ~ ` 5 ~, ~~~ ~ ~~ _ (~, _
Pursuant to notices given, the undersigned offers bid(s) to ~-l ~ ~ - J~7' ~ ~-~''~~J(~ IE.' ,<-
(Governmental Unitj in accordance with the following attachment(s) which specify the class or item number or
description, quantity, unit, unit price and total amount.
The contract ~•~ill be awarded by classes or items, in accordance with specifications. Any changes or altera-
tions in the items specified will render such bid void as to that class or item. Bidder promises that he has not
ofFe.red nor received a less price than the price stated in his bid for the materials included~in said bid. Bidder fur-
ther agrees that he will not withdraw his bid irorn the office in which it is filed. A certified check or bond, shall
be filed with each bid if required, and liability for breach shall be enforceable upon the contract, he bond or.cer-
tified check or both as the case may be.
~~
` Signature of Bidder or Agent
BID OFFER OR PROPOSAL
Attach separate sheet listing each item bid based on specifications published by governing body. Following
is a.n example of the bid format:
Class or Item Quantity Unit __ Description Unit Price Amount
~'TATE OF INDIANA) '
ss:
OUNTY)
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 agent of the firm, company, corporation or partnership represented by him, 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 induce anyone to refrain from bidding, and that this bid is made without
reference to any other bid and without any agreement, understanding or combination with any other person in
reference to such bidding.
f-ie further says that no person or persons, firms, or corporation has, have or will receive directly or indirect-
ly, any rebate, fee, gift, commission or thing of value on accou t of such sale.
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Biyjd~r (F' ) r
Signa re q,f Bidder or A Cy "' ( -
Subscribed and sworn o before me this ~~ ~ d y of ~~Jlf, , f~-- ,'~
MAI~C~W~ICY OIL C®., INC.
1626 Fabricon Blvd.
P.O. Box 37
Jeffersonville, IN 47131-0037
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