PROPOSAL FORM 2014 FUEL BID

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PROPOSAL FORM 2014 FUEL BID COUNTY OF SIBLEY, MINNESOTA BIDS CLOSE: NOVEMBER 22, 2013 AT 4:30 P.M. PROPOSAL TO: SIBLEY COUNTY PUBLIC WORKS TIMOTHY BECKER PUBLIC WORKS DIRECTOR 111 8 TH STREET PO BOX 897 GAYLORD, MN 55334-0897 PROPOSAL OF: (CONTRACTORS NAME) (ADDRESS) (ADDRESS) (PHONE) The undersigned has examined the Proposal and specifications and is familiar with the nature of the work and local conditions affecting the cost of the work and hereby proposes to furnish all labor, product and equipment required for the complete delivery of the products described in strict accordance with all requirements of the Proposal as follows: PAGE PF - 1

We, the undersigned Supplier, propose to deliver the following fuels to the supply tanks at the various maintenance shops in Sibley County and on site deliveries throughout the county to various pieces of equipment for the Contract term of 1/1/2014 through 12/31/2014 as according to the following fuel bid proposal: It is agreed: 1. That the fuel delivered will meet the specifications on Pages PF-5 through PF-6 and that there is no set quantity of fuel called for but that delivery will be made at the request of the Public Works Director or his designated representative. 2. That the undersigned Supplier will include a certified check or bidder s bond in the amount of $500.00, payable to Sibley County Treasurer, with this fuel bid proposal. 3. That any time the posted rack price increases or decreases, please notify the Sibley County Public Works Office with a copy of the notification you receive from your supplier stating the price change. 4. Further, we agree that the fuel bid proposal shall be made as follows: i. Rack price plus delivery cost plus markup plus StateTax (for gasoline only) plus any other applicable fees in effect such as the Petrofund clean-up fee. The price per gallon must be stated as of today s date, for comparative purpose in making the award. ii. Bids shall be itemized by maintenance shop location and product type on the provided fuel bid forms. 5. Sibley County Public Works is not subject to Federal Tax on Gas and Diesel Fuel and Sibley County is not subject to State Tax on Diesel Fuel. 6. Supplier shall furnish product specifications on all products bid, the name of terminal and their phone number. The specifications provided shall include documentation to easily compare the supplied product with the specifications contained in this proposal. 7. Each invoice will be charged out with a legible stamped meter reading on a single ticket and the correct bid price and dollar amount at time of delivery. Invoices without a stamped meter reading will not be paid. 8. Tank sizes vary from 1,000 gallons to 2,000 gallons. PAGE PF - 2

Accompanying this bid is the cash deposit, certified check or bidders bond in the amount of DOLLARS CENTS ($ ), made payable to the County Treasurer and the same is subject to forfeiture in the event of default on the part of the undersigned or failure on the part of the undersigned to execute the prescribed Contract Documents within a period not to exceed ten (10) days after its award, if awarded to the undersigned. In submitting this bid, it is understood that the County Board of Commissioners retains the right to reject any and all bids and to waive irregularities and informalities therein and to award the Contract to the best interest of the County. In submitting this bid it is understood that payment will be by check, upon a duly processed claim form. It is understood that bids may not be withdrawn for a period not to exceed sixty (60) days after the date set for the opening of bids. The County Board of Commissioners reserves the right to retain the cash deposit, certified check or bidders bond of the three lowest bidders as determined by the County for a period not to exceed sixty (60) days after the date set for the opening of bids. ACKNOWLEDGE ADDENDA BY INSERTING NUMBER AND DATE BELOW: ADDENDUM NUMBER DATE RECEIVED Respectfully submitted, BIDDER IS: (CORPORATION) (PARTNERSHIP) (INDIVIDUAL) FIRM: BY: (Printed Name of Signer) TITLE: ADDRESS: TELEPHONE: PAGE PF - 3

AFFIDAVIT OF NON-COLLUSION I hereby swear (or affirm) under the penalty for perjury: (1) That I am the bidder (if the bidder is an individual), a partner in the bidder (if the bidder is a partnership), or an officer or employee if the bidding corporation having authority to sign on its behalf (if the bidder is a corporation); (2) That the attached bid or bids have been arrived at by the bidder independently, and have been submitted without collusion with, and without any agreement, understanding, or planned common course of action with, any other vendor of materials, supplies, equipment or services described in the Advertisement for Bids, designed to limit independent bidding or competition; (3) That the contents of the bids or bids have not been communicated by the bidder or its employees or agents to any person not an employee or agent of the Bidder or its surety on any bond furnished with the bid or bids, and will not be communicated to any such person prior to the official opening of the bid or bids; and (4) That I have fully informed myself regarding the accuracy of the statements made in this affidavit. Signed: Firm Name: Subscribed and sworn before me this day of,. Notary Public: My commission expires: PAGE PF - 4

General Special consideration will not be given for standards and specifications exceeding minimum requirements. The Supplier shall include specifications of the product being supplied with the submission of the fuel bid proposal. Standard Specifications for Automotive Gasoline (ASTM D 4814) 1. Meet the requirements of ASTM D 4814 (current specification). 2. Unleaded gasoline shall be blended with ethanol to meet State of Minnesota statute requirements. Premium Diesel Fuel Specifications (ASTM D 975) I. SCOPE: This specification covers 5% (B5) Biodiesel/Diesel Fuel Blends. The blends shall consist of the specified percentage of Biodiesel using Grade S15 (B100) Biodiesel Fuel Blend Stock and S-15 Ultra Low Sulfur (ULS) Premium Diesel Fuel or Winter Premium Diesel Fuel. For example, B5 will contain 5% Grade S15 (B100) Biodiesel Fuel Blend Stock and 95% Ultra Low Sulfur (ULS) Premium Diesel Fuel or Winter Premium Diesel Fuel. II. REQUIREMENTS: Biodiesel/Diesel Fuel Blends shall be combinations of 100% Biodiesel stock, No. 1-D, No. 2-D and Winter Premium Diesel Fuel at the proportions requested by Sibley County Public Works. The Biodiesel (B100) Fuel Blend Stock used for producing Biodiesel/Diesel Fuel Blends shall meet the requirements for Grade S15 B100 in ASTM D6751 (current specification) for Biodiesel Fuel Blend Stock (B100) for Middle Distillate Fuels prior to blending B5. B5 Premium Diesel Fuel Blends shall conform to the requirements of ASTM D-975 (current specification) Grades with modifications listed below: B5 Biodiesel/Diesel Fuel Blend Sulfur, ppm, Max. Cloud Point F Max. Calculated Cetane Index, Min. B5/ULS 1-D S-15 15-30 45 B5/ULS 2-D S-15 15 15 45 B5/Winter Premium Diesel Fuel Blends shall conform to the requirements of ASTM D-975 (current specification) B5/ULS 1-D S15 or B5/ULS 2-D S15 Grades with modifications listed below: Winter Premium ASTM Test Method Specification Biodiesel/Diesel Fuel Blend Flash Point, F D-83 140 min Calculated Cetane Index D-976 47 min Cloud Point, F D-2500-10 max PAGE PF - 5

CFPP ( F) D-6371-35 max Kinematic Viscosity, cst D-445 1.3 4.1 Color D-1500 2.5 max III. ADDITIVES: Biodiesel/Diesel Fuel Blends shall have the following additives: 1. A lubricity additive to protect the injection pump and injector from wear and early failure. 2. A detergent/dispersant to assure maximum power, economy component life, minimize smoke, filter plugging, and help prevent or reduce deposits in the fuel system. 3. A stabilizer which maintains fuel quality, reduces degradation under high fuel temperatures and improves storage life. 4. A de-icing agent during the months of October through March. IV. BLENDING: Biodiesel/Diesel Fuel blending, mixing or the addition of additives must be done at the Contract Vendor s location or its subcontractor s location, and/or refinery. Manifold or tank blending at time of delivery is not allowed without approval of Sibley County Public Works. V. SAMPLING: Samples shall be taken from the tanker at the time of delivery, if requested by Sibley County Public Works. Sample containers shall be one quart metal cans with tightfitting screw top lids. VI. TESTING: Testing shall be done according to test methods referenced in ASTM D-975 (current specification) or other appropriate test methods. PAGE PF - 6