CITY OF BARTLETT 6400 STAGE ROAD BARTLETT, TENNESSEE 38134

Transcription

1 CITY OF BARTLETT 6400 STAGE ROAD BARTLETT, TENNESSEE A. Keith McDonald, Mayor Mark Brown, Chief Administrator Officer Dick Phebus, Finance Director Bill Yearwood, Director of Public Works REQUEST FOR SEALED BIDS SB # FY DUE: Thursday, November 2, 2017, no later than 2:00 p.m. (CST) SINGLE AXLE DUMP TRUCK - 10 WITH Public Works Fleet The City of Bartlett Public Works Fleet is seeking to purchase one (1) 2018 Single Axle Dump Truck - 10 with Snow Plow and Salt/Sand Spreader as per the written specifications.

2 NOTICE TO BIDDERS Sealed Bids are to be received no later than 2:00 P.M. on Thursday, November 2, All bid packets, with an original, clearly identified, and two copies, must be labeled 2018 SINGLE AXLE DUMP TRUCK - 10 WITH and addressed as follows: MAYOR A. KEITH MCDONALD CITY OF BARTLETT 6400 STAGE ROAD BARTLETT, TENNESSEE The City reserves the right to reject any and all bids and to waive any informality in the bidding process. The City of Bartlett is an equal opportunity employer. If further information is desired, please contact Debbie Cairncross, Purchasing Agent at or dcairncross@cityofbartlett.org Please quote prices on attached bid sheet. We propose to furnish the item(s) listed on attached form(s) at prices quoted and guarantee safe delivery FOB Delivery as specified. These prices are submitted with a declaration that no Bartlett Aldermen or Employee has a financial or beneficial interest in this transaction. NAME OF FIRM ADDRESS PHONE SIGNATURE OF AUTHORIZED REPRESENTATIVE PRINT NAME DATE 2

3 INTENT The intent of these specifications is to provide sufficient specified information to permit prospective bidders to submit proposals on one (1) 2018 Single Axle Dump Truck - 10 with Snow Plow and Salt/Sand Spreader with Dump Body. The awarded supplier will be required to deliver the tractor F.O.B. to the City of Bartlett Fleet Services at 3583 Altruria Road, Bartlett, TN STATEMENT OF INTENT EQUALITY AND FAIRNESS The City of Bartlett will not discriminate against any individual of any reason and will provide services to all citizens in a nondiscriminatory fashion. It is the intent of the city to fully comply with the provision of Title VI and Title VII of the Civil Rights Act of The City is committed to a moral, ethical, and legal responsibility to ensure equitable employment practices and the delivery of city services regardless of an individual s race, color, religion, national origin, age, disability, gender or political affiliation. GENERAL SPECIFICATIONS These specifications are intended as minimum requirements. However, it is recognized that each manufacturer has special features that make his equipment unique. Therefore, all bids will be considered, but every bidder must state, in detail, where his product fails to meet these specifications. Unless otherwise stated, these specifications are not intentionally written to favor any one manufacturer, and are only for the purpose of indicating generally the type of work required of said bid items. It is the intention of the City to purchase quality products and not necessarily the products with the lowest initial cost. The City also reserves the right to reject any and all bids. 1. All bidders must clearly identify any and all deviations from these specifications that their products may have; however, bids must meet or exceed specifications. 2. Bidder MUST include the bid specification compliance list, along with the signed pricing sheet and the signed and notarized Public Acts 109 form (page 25). Note: An original, clearly marked, and two copies shall be included in the bid package. 3. All prices are to be firm for 120 days from bid due date. 4. The City reserves the right to reject any and all bids. 5. The bid shall state the manufacturer s warranty, along with owner s manuals. 6. An Award Letter and purchase order will be issued to the successful vendor. 7. All charges for transportation and unloading are to be pre-paid by the successful bidder, and are not the responsibility of the City of Bartlett. 8. Unit delivered as a result of the award of this bid shall be a current year model, new and unused. Note: Bidder may include any additional information or brochures on equipment being presented in the bid package. 3

4 DETAILED SPECIFICATIONS (Include one original and two copies with bid pricing sheet) 2018 SINGLE AXLE DUMP TRUCK - 10 WITH AND DUMP BODY Truck Specifications 2018 Conventional Cab-chassis, Freightliner M2106 or equal Engine and Components Diesel, in-line, 6-cylinder, 280 HP, 660 lb. ft. of torque to meet 2010 carb emission certification, provided with: DEF tank with gauge in cab Single-stage dry-type air cleaner with restrictor indicator Variable speed governor 12-volt starter Fuel/water separator 120-volt engine block heater Transmission Allison 3500 RDSP or equal, 6 speed electronic automatic with PTO provision Front Axle and Suspension Front Axle 8,000 lb. capacity Front Suspension 8,000 lb. capacity Shock Absorbers, double-acting, telescopic Power Steering 4

5 Rear Axle and Suspension Single-speed Rear Axle, 17,500 lb. Lube Drive Line, extended and inter-axle drive line. Rear Suspension, 20,000 lb. with rear shock absorbers Rear Axle ratio, 5.88 Auxiliary Rear, 4,500 lb. Magnetic drain plug Brakes Full Air Brakes, ABS cam-type with automatic front and rear slack adjusters Parking Brake, spring set Front Brakes, 15.0-inch x 4-inch Q+ with brake dust shields Rear Brakes, 16.5-inch x 7-inch Q+ with brake dust shields Air Dryer, heated Air Compressor, 18.7 CFM Fuel Tank Fuel Tank, 80 gallon capacity, mounted on left hand side Electrical Electrical System, 12V with circuit protectors Alternator, 160 amp with remote battery sensor Batteries, two (2) heavy-duty, maintenance free, 1900 total CCA minimum 5

6 Wheels and Tires Wheels x 8.25 hub piloted, 0-stud steel Front Tires - 11R22.5H 16PR highway tread Rear Tires - 11R PR, mud/snow tread Cab Equipment Aluminum Shell Cab Seats Air suspension driver s seat, two-man passenger seat with under seat storage, vinyl seat covers Glass tinted all around Sun Visors, left and right hand Safety back-up alarm Side Mirrors stainless steel west coast style with convex spot mirrors Fender Mounted Mirrors left and right hand convex Windshield Wipers Intermittent with washer Air Conditioning integral with heater and defroster Radio Am-FM stereo with weather band, two (2) speakers Bluetooth and USB port Power point, 12 volt Steering column tilt and telescopic Bumper, painted steel Towing Provision, chassis manufactured Tow Hooks, two (2) attached to front frame 6

7 Cab/Chassis Warranty Engine - 24 month/250,000 mile warranty Transmission - 36 months/unlimited miles Full Towing Coverage 24 month/unlimited miles Basic Vehicle - 24 month/unlimited miles Battery - 12 month/100,000 miles Drivetrain - 24 month/unlimited miles Cab Structure - 60 month/unlimited miles Cab Perforation/corrosion - 60 months/unlimited miles Frame Rail Cab Perforation/corrosion - 60 months/unlimited miles Crossmember - 60 months/unlimited miles Paint - 6 months/unlimited miles End of Cab/Chassis Specifications 7

8 Specifications Dump Body Dimensions Minimum 10 long x 96 outside body width, 54 sides Floor Shall be 10 Ga., two-piece, with 2 radiused corners Note: No Dog House Headboard 36 high full width integral V-type horizontal bracing 10 Ga. High tensile steel A572 grade 50 construction Provide one (1) strobe light mounted on headache rack, Star Mini-Bar 9100 LED-AA-C or equal Understructure 6 structural channel longitudinals 4 structural channel crossmembers on 12 centers Crossmembers are gusseted and welded to the longitudinals Sides Shall be 30, 10 Ga. High tensile steel A572 grade 50 with boxed top rails Sides supplies with 6 tall x 2 wide, front and rear board pockets Allowing 36 total side height 36 corner post (full depth on rear) fully welded to the body Tailgate Shall be 364 tall, 10 Ga. High tensile steel A572 grade 50 3-panel con construction Double acting with spreader chains, double cast banjo eyes on each side Rear lower air controlled tailgate latch and over cam cast latch 8

9 Top latch with cast L brackets and forged pin latch. Fully boxed and welded tailgate frame with 35 degree dirt shedder structure on lower frame Hoist Hoist to be a National Truck Equipment Association certified, class 50. Note: to minimize fitting problems, hoist and body must be manufactured by the same manufacturer Single-cylinders, 8-inch double-acting sub frame scissors hoist system, Note: No Telescopic Allowed. 50 degree dump angle, minimum Mounting Height to be 7-1/2 Sub-frame constructed with A572, grade 50 high tensile steel and 4140 grade weldable castings End of Dump Body specifications 9

10 Specifications Hydraulic Powered Reversible Snow Plow Minimum Moldboard requirements Quick Mount Lift Design allows continuous level Lift in any position Height 31 Length 10-0 Cutting Path at 35 for a 10-0 length is Ga. 304 stainless steel rolled with six (6) 1/2 x 3-1/2 rolled ribs for extra strength and rigidity Trip Springs Six (6) to evenly space out the trip force Cutting edge 5/8 x 8 one-piece powder coated with AASHO punching Belted Deflector 12 Shoes Cast iron Reversible Bolt on rubber cutting edge blade Top Angle -3-1/2 x 2-1/2 x 3/8 inch top angle with drain holes to allow moisture to escape Attack Angle - Four (4) position attack angle is adjustable from 5 to 20 Horizontal Braces Two (2) horizontal braces for added rigidity Push Frame Linkage operated quick disconnect hitch system Dual halogen dual beam plow lights on secure double post mounts Lift arm cylinder 2-inch x 6-inch with 35-degree travel Angle cylinders 2-inch x 12-inch 10

11 Specifications Central Hydraulic System Hydraulic Pump Capacity Minimum capability must be engine RPM; P.T.O. driven by transmission pump. Reservoir/Valve Enclosure Hydraulic Reservoir/Valve Enclosure - shall be framemounted with a 15-gallon capacity Reservoir Finish - Shall be black epoxy powder coated and have an ASTM 8 rating at 336 hours of salt spray Reservoir shall be equipped with the following: Magnetic Drain Plug 3/4" in size Brass Ball Valve Full flow, 1-1/4 NPT Suction Strainer - With 100 mesh screen and 3-PSI bypass valve, 2 x 1-1/4 tank mount return line filter with a built in breather, and sight/temperature gauge externally mounted facing front of truck no matter which side enclosure is mounted Reservoir Filling Shall will be through the filter housing with a flow path that will filter all new oil entering the system. Hydraulic Reservoir - Shall be constructed of 10-gauge material and internally baffled, Note: Mounting bracket shall be designed and supplied by reservoir supplier; designed in a manner as to not transmit torsional loads through the reservoir Enclosure - Shall use a gasket-less passive seal technology (no rubber seals, gaskets or weather stripping or bolts); lid shall be removable by one person without the use of tools Hydraulic Reservoir Cover - Shall protect the following from road and pressure washer spray: hydraulic valve, all valve fittings, hose ends, tank mount return line filter and breather, visual and electrical bypass sending units, return line to filter any electrical connections. Note: Use of bulkhead fittings is not acceptable; directional control valve must be accessible on all 6 sides without removing valve from enclosure for ease of service 11

12 Valve Mounting Plate - Must swing out for ease of valve service and hose replacement Reservoir/Valve Enclosure - Shall be Force America Inc. VT15 Valve/Tank Assembly or prior approved equal Filter Shall be mounted in the reservoir and be a 16-micron absolute, rated for no less than 30 GPM Model #TEF21016VG16SP-UG60 or prior approved equal Include visual bypass indicator System shall be delivered with one spare filter element Hydraulic Control Valve Hydraulic Valve - Shall be a modular stackable manifold with level port design; each hydraulic function requires an individual manifold be stacked together to form the manifold base Inlet shall consist of SAE #12 inlet porting, SAE #16 outlet porting and optional SAE #16 power beyond and SAE #4 load sense An adjustable main relief shall be contained within the inlet to limit system pressure Inlet will be capable of use with a gear type pump. Note: The use of an electric unloader and double pull double throw electric switches is prohibited. All valve manifolds shall be manufactured from 6061-T6 aluminum and be anodized to MIL-A-8625F Hydraulic Valve Section Each shall be serviceable without removing any hydraulic hoses or any other hydraulic components Options the following options must be contained in the hydraulic valve manifold: Hoist section should contain a downside direct acting relief adjustable from 300 to 1800 PSI to protect the truck frame from forces associated with power hoist lower 12

13 A counter balance valve is also to be contained within the hoist manifold to maintain a constant down speed regardless of the load The plow lift valve is to contain an adjustable port relief to limit the plow raise PSI. Both the hoist and plow lift sections shall have leakage rates of less than 2 cc/minute to prevent unwanted drift. Plow turn shall contain a cross-port relief to protect the turn cylinder from external loads. Valve stack must be capable of inserting a Spin-A-Veyer valve for sander control; sander controls will be a pressure compensated proportional flow control so that speed of functions will remain constant no matter what system pressure is. Note: Power beyond to sander valve shall not be permitted. Valve segments shall be Force America Add-A-Fold Model 2010 or prior approved equal Valve to be arranged as follows: a. Hoist: 4-way with down side relief set at 500 PSI b. Plow Lift: 3-way with float with work port relief set at 2000 PSI. c. Plow angle: 4-way with cross-port relief set at 2500 PSI. Spin-A-Veyer section, consisting of: a. two (2) pressure compensated cartridges that are a single piece design with hardened cartridge bores and spools b. Shall operate independently via a 12V DC pulse width modulated signal c. Each valve shall have heavy duty 7/16-20 UNF screw from no flow to full flow 13

14 d. Valves shall be mounted in a housing that is made of aluminum with gray anodizing for corrosion resistance and durability. e. Auger/conveyor shall be a 15 GPM spool f. Spinner shall be a 7 GPM spool. Hydraulic Lines and Plumbing All hydraulic lines and plumbing shall be of sufficient capacity so as not to create heat or turbulence within hydraulic system. Suction line between reservoir and pump shall be a minimum of 1-1/4-inch I.D. with a minimum SAE 100-R4 rating and shall be secured on both ends via heavy duty banding straps, Note: Radiator hose clamps unacceptable. All pressure hoses, including signal sense to pump shall have swivel fittings on both ends and have a minimum SAE 100-R2 rating Return lines and case drain shall have a minimum SAE 100-R1 rating Hydraulic lines shall be routed to minimize interference with equipment and chassis components requiring periodic servicing. Support brackets, grommets, and tie wraps shall be provided where appropriate to protect lines from damage by abrasion, cutting or impact. Hoses shall not be routed near exhaust manifold pipes, bolts, sharp edges, and exhaust system to prevent wear, fatigue, or fire. Note: Pipe fittings are not acceptable in any highpressure line. Maximum distance between support clamps on all hydraulic lines shall be 24-inches. Spreader Control Console Electronic spreader control shall be a FORCE America 5150EX-9F-JOYSTICK or prior approved equal Shall include proportional controls for auger, spinner, and anti-ice spreader functions and shall be integrated into a small, rugged, plastic injection molded control box and: 14

15 a. Controller shall also be capable of reversing auger and cross conveyor. b. Auger and anti-ice functions shall be operable in manual mode, open loop mode, and closed loop mode. c. Spread rates for granular, spinner, and anti-ice functions shall be operable in manual mode, open loop mode, and closed loop mode. d. Spread rates for granular, spinner, and anti-ice shall have the ability to be adjustable inside of calibration. Materials shall be capable of being named. e. A security code shall be selectable in calibration to lock out undesired changes to the calibration settings, supervisor USB key shall be available for quick access to the calibration menu. f. While in multi-lane mode the left, center and right lane ball valve outputs shall be controlled by comfortable, backlit rocker switches molded into the controller above the display. When all of the lane valves are deactivated, the anti-ice shall enter standby mode automatically. Controller shall be modular in design for ease of installation and service and: a. Controller shall be capable of being mounted anywhere in the cab; RAM mount shall be used to allow for easy installation and swivel capabilities. b. Wiring connectors shall be keyed with wiring labeled throughout. c. Spreader harness shall include DIN connectors that illuminate when the output is active. d. All components must be durable for long life and trouble free operation. 15

16 e. Spinner and spreader control dials shall be on the right side of the controller to allow for a clear view of the display while being adjusted. f. Spinner and spreader control knobs shall be color coded and correlated with the granular and spinner settings on the screen. g. Enclosure shall provide a built in, protective surrounding around the spinner and spreader control knobs to prevent unintentional use and damage to the knobs. Controller shall operate a straight blade plow and dump body and: a. Outputs shall be controlled by backlit rocker switches molded into the controller above the display. b. An interlock switch integrated into the back of the controller shall be required to operate the hoist function to comply with all OSHA related regulations. c. Controller shall be capable of moving the plow up, down, left, and right, provided with a remote mounted joystick console that can be removed in the summer. d. Joystick console shall offer both plow and hoist control via a single joystick and shall be dual axis non-proportional with a pushbutton on top. Note: In normal operation, the up/down and left/right axis shall control the front plow. e. While the push-button on top is depressed, the up/down axis shall now operate the dump body and the left/right axis shall be dead. f. Joystick box shall include two (2) separate knobs to control the spreader rate and spinner speed output rates, knob shall be color coded to match those on the actual spreader console. 16

17 g. Shall be two rocker switches to operate manual mode on/off and pre-wet on/off. h. Joystick console shall wire to the main spreader control via single cable only which can easily be disconnected from either the joystick console or spreader console. i. Shall also be a RAM mount ball on the back for ease of mounting. Controller shall include off the shelf integration with PreCise brand GPS/AVL systems for advance material logging and maintenance reporting and: a. Controller shall provide onboard current event and season totals for granular materials. b. An integrated USB port shall be used for data retrieval, firmware upgrades, and for loading and saving of calibration settings Controller shall include a 3-1/2-inch high brightness, color, touch screen LCD with adjustable backlighting and: a. Touch-screen shall be used for calibration only and shall not be needed during normal spreading operation. b. Touch screen shall allow for easy navigation of calibration menus and data viewing menus. c. The screen shall display warnings for oil level, oil temp, filter bypass, low granular material, and granular feedback errors Audible warnings shall coincide with each visual warning and shall be individually adjustable and: a. Shall have a dedicated red LED on the face of the controller for an additional body up indicator b. LED shall not rely on software of the controller to operate. 17

18 Spreader control shall be tested by a SAE certified testing laboratory and shall meet all the following electrical, RF and environmental testing standards within the specified ranges Electrical and RF Testing: a. SAE J1113/4: BCI Sweep Range 1-400MHz, test at 100mA levels, CW and 1kHz AM 80% modulations, 15/45/75cm injection distances b. SAE J1113/11: Load Dump Test - test pulse 5A, 24V system, 150V Peak, applied five (5) times, 10s between pulses c. SAE J1113/13: Operating Operating at 4 & 8kV Direct, 4/8kV air discharge, 330pF/2kohms, three (3) each +/- d. SAE J1113/21: Absorber-lined shielded enclosure radiated immunity sweep range MHz, Levels to 100V/m, use CW, AM, and pulse ( MHz only) horizontal and vertical antenna polarities, 1 DUT orientation e. CISPR 25: RF radiated emissions sweep range 150kHz-2.5GHz, DUT orientation, horizontal and vertical antenna polarities f. Pass CISPR Class 3 through entire test range g. Pass CISPR Class 4 from 30MHz-2.5GHz Environmental Testing: a. SAE J1455 sine vibration 2G Test level, Hz swept rate TBD, run for 3 hours per axis. b. SAE J1455 Random vibration, 5-500Hz, 3 hours per axis c. SAE J1455 Operational shock 20g s, 11ms, ½ sine pulse, apply 3 shocks each direction, each axis [18 shocks total] 18

19 Salt-Sand Stainless Steel Spreader Box Minimum box requirements: a. Capacity to be 7 cubic yards struck b. Inside length to be 10-0 c. Inside top width to be 84 d. Side slope to be 45-degrees minimum. e. Hopper seams to be continuous welded on inside. f. Sides, ends & side supports to be 10 Ga. 304 stainless steel g. Top edge of hopper is formed J channel 2 x 1-1/2 h. Auger trough is to be 10 Ga. 304 stainless steel i. Long sills to be 10 Ga. 304 stainless steel, continuous welded to side sheet j. Cross sills to be formed 7 Ga. 304 stainless steel welded to side supports k. Lift hooks on each corner shall be 5/8 stainless steel round bar l. All hardware shall be stainless steel m. Grate screens shall be 3/8 rod on 3/8 rod top with antifreeze hinges n. Strobe light, shall provide one (1) LED unit mounted on top of rear of spreader with control switch in truck cab o. Flood/work lights, shall provide two (2) LED units mounted on top of rear of spreader with control switch in truck cab 19

20 Minimum Auger requirements: a. Shall have a 7 diameter hard faced variable pitch auger conveyor b. Shall have a 64 CIR direct drive hydraulic motor c. Motor shall be directly coupled to end of auger shaft d. Auger shaft shall connect at front with a 2 four-bolt flange bearing e. Auger shafts shall utilize a polyurethane bushing at motor end of auger to eliminate seizing and ensure ease of maintenance f. Rear auger drive shall have a motor guard bolted to rear Spinner Chute Assembly a. Shall be 10 Ga. 304 stainless steel enclosed design b. Shall have a four-position telescopic adjustment c. Shall have one (1) baffle positioned at the bottom of the spinner chute to direct flow of material onto spinner disc for directional spread pattern adjustment d. Shall have five (5) positions of adjustment without the use of tools e. Baffle shall utilize a 304 stainless steel notched bar that pins into position for positive lock f. Shall have four (4) bottom spinner deflectors, overlapping to prevent loss of granular material when the deflectors are raised; front deflector shall be fixed g. Bottom over-lapping spinner deflectors shall have four (4) positions of rod and pin adjustment without tools. Note: Chain adjustable deflectors are not acceptable 20

21 h. Provide poly 18 diameter spinner disc with replaceable machined hub i. Spinner hydraulic motor shall mount directly on bottom of spinner Tailgate Lock Kit Main latch bar shall be 3 x 4.1 Lb. structural channel, 84 wide Shall have two (2) 3 x 4.1 Lb. x 8 structural channel with two (2) 1/2" x 1-1/2 mounting hole welded to main channel Shall have two (2) 1-1/4 x 7 round stock tailgate latches to be hole welded to main channel Accessories Body shall be equipped with a 15,000 lb. receiver hitch with safety chain attachments, air brake connectors, ICC bumper and 7-blade electric plug mounted on 1/2 plate All body lights shall be rubber-grometted mounted with pop-out capabilities Body shall be equipped with an electric tarp system that has aluminum arms mounted behind the integrated wind deflector on the cab shield that has controls in the cab with a minimum of a 18-0 long tarp that is made of mesh material. Four (4) LED amber lights shall be mounted in the front grill, Federal Signal Part #MPS600U-WA or equal Two (2) 6- oval amber LED flashing lights shall be mounted in the rear post of dump bed, Part #60362R/Y or equal. Mounting and Painting Body and hoist shall be mounted within industry standards All metal surfaces are to be high-pressure cleaned with a phosphate solution to remove slag, splatter, oxide and oil residue 21

22 Body and hoist shall be cleaned, primed and powder coated black Non-stainless steel parts shall be painted or powder coated black All 304 stainless steel components shall be unpainted Assistance & Training Bidder shall provide a minimum of six (6) hours of training and assistance to Fleet personnel on the proper operation and maintenance of the unit. A determination will be made by Fleet Services if a lesser amount of time is needed for training. End of Snow Plow and Salt-Sand Spreader Specifications 22

23 ALL WARRANTY INFORMATION TO BE PROVIDED UPON DELIVERY OF VEHICLE. ALL WARRANTY WORK TO BE DONE WITHIN 50 MILES OF BARTLETT CITY LIMITS Successful Bidder Must State Address of Factory Authorized Parts And Service Facility: WARRANTY Specify all warranties available: OWNERS MANUALS Furnish ALL manuals (2 sets) DVD format preferred however, book format is acceptable Service/Repair Manual Parts Manual Operation and Maintenance Manual DELIVERY Note: At the time of delivery, equipment must meet or exceed all federal, state and local safety, health, lighting and emission standards Dump body and Snow Plow and Salt-Sand Spreader to be mounted on the Truck Chassis and must be delivered to: City of Bartlett Fleet Services 3583 Altruria Rd. Bartlett, TN

24 BID PRICING SHEET (Include one original, clearly marked, and two copies, the specification check list and the Public Acts 109 form) Single Axle Dump Truck - 10 with Snow Plow and Salt/Sand Spreader Delivered Price $ Total Bid in Words: Time required for delivery: days. NOTE: BID PRICING TO BE FIRM FOR 180 DAYS, WITH AN OPTION TO PURCHASE ADDITIONAL VEHICLES WITHIN ONE YEAR FROM BID DUE DATE AT THE SAME PRICE NAME OF FIRM Authorized Representative (Typed or Printed) Phone Number Authorized Representative Signature Date 24

25 PUBLIC ACTS 109 By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalties of perjury, that to the best of its knowledge and belief that each bidder is not on the list created pursuant to Full text of Public Chapters can be found on the Tennessee Secretary of State s website: PublicActs.109.php. Print Name_ Signed Title Subscribed and sworn before me this day of, 20. Signed Print Name Title My commission expires:, 20. NOTE: Bids cannot be considered nor awards made to anyone without the above required statement. 25