REQUEST FOR BID #18-05                                                                                   October 25, 2004

 

UNIVERSITY OF MAINE

PURCHASING DEPARTMENT

ORONO, MAINE  04469-5765

 

The University of Maine System, acting through the University of Maine, is seeking bids for the purchase of uniforms for Student Auxiliary Services/Dining Services according to the following specifications.

 

 

1.0     GENERAL INFORMATION

 

1.1        Definition of Parties:  The University of Maine will hereinafter be referred to as the "University."  Respondents to the RFB shall be referred to as "Bidders."  The Bidder to whom the contract is awarded shall be referred to as the "Contractor."

 

1.2        Alternates:  Unless otherwise provided for in this solicitation, the name of a certain brand, make or manufacturer does not restrict bidders to the specific brand, make or manufacturer named; but conveys the general style, type, character, and quality of the article desired.  Any article which the University, in its sole discretion, determines to be the equal of that specified, considering quality, workmanship, economy of operation, and suitability for the purpose intended, shall be accepted. It is the bidder's responsibility to clearly and specifically indicate the product being offered and to provide sufficient descriptive literature, catalog cuts and technical detail to enable the University to determine if the product offered meets the requirements of the solicitation.  Failure to furnish adequate data for evaluation purposes may result in declaring a bid non-responsive.  Unless the bidder clearly indicates in its bid that the product offered is an "equal" product, such bid will be considered to offer the brand name products referenced in the solicitation.

 

1.3        Award:  It is the intent of the University to award this bid all to one vendor.  The University reserves the right to conduct any tests it may deem advisable, and to make all evaluations.  The University reserves the right to reject any or all bids, in whole or in part, and is not necessarily bound to accept the lowest bid if that bid is contrary to the best interests of the University.  The University reserves the right to waive minor irregularities.  Scholarships, donations, or gifts to the University will not be considered in the evaluation of bids.  A bid may be rejected if it is in any incomplete or irregular.  When there are tie bids, there shall be a preference for “in-state bidders”.  When tie bids are both in-state or both out-of-state, the award will be made to the bid that arrives first in the Purchasing Department.

 

1.4        Bid Envelope:  If a special envelope is not furnished, or if return in the special envelope is not possible, the signed bid should be returned in an envelope or package, sealed and identified as follows:

 

                                    From  ________________     __________ __________ __________

                                    Name                     Due Date            Time                Bid No.

 

1.5        Communication with the University:  It is the responsibility of the bidder to inquire about any requirement of this RFB that is not understood.  Responses to inquiries, if they change or clarify the RFB in a substantial manner, will be forwarded by addenda to all parties that have received a copy of the RFB.  Addenda will also be posted on our web site, www.umaine.edu/purchasing/.  The University will not be bound by oral responses to inquiries or written responses other than addenda.  Inquiries must be made to:

 

 

 

 

                                                                  Anne-Marie Nadeau

Purchasing Department

University of Maine

5765 Service Building

Orono, Maine 04469-5765

(207) 581-2690

 

1.6        Costs of Preparation:  Bidder assumes all costs of preparation of the bid and any presentations necessary to the bidding process.

 

1.7        Evaluation:  Award will be made to the low bidder provided that all other requirements are satisfactorily met.  However, consideration will be given to delivery and references.

 

1.8        Specification Protest Process and Remedies:  If a bidder feels that the specifications are written in a way that limits competition, a specification protest may be sent to the Purchasing Department.  Specification Protests will be responded to within five (5) business days of receipt.  Determination of protest validity is at the sole discretion of the University.  The due date of the bid may be changed if necessary to allow consideration of the protest and issuance of any necessary addenda. Specification protests shall be presented to the University in writing as soon as identified, but no less than five (5) business days prior to the bid opening date and time.  No protest against the award due to the specifications shall be considered after this deadline. Protests shall include the reason for the protest and any proposed changes to the specifications. Protests should be delivered to the Purchasing Department in sealed envelopes, clearly marked as follows:

 

                                    SPECIFICATION PROTEST, RFB #______

 

1.9        Samples:  DO NOT SEND SAMPLES WITH YOUR BID.  Bidders may be asked to provide a sample for each item offered prior to award.   Samples shall be exact and true representatives of the material offered.  Each sample shall be properly tagged or labeled with the name of the bidder, the bid opening date, and the specific commodity or item number.  Samples shall be provided at no cost to the University.  In the event the delivered product fails to conform to the sample provided, the Contractor shall immediately replace the portion of the delivered commodity with acceptable material conforming to the contract requirements at no additional cost to the University.  Samples provided by successful bidder will remain with the University for comparison purposes.  Samples from all other bidders can be picked up upon award of the bid. 

 

Upon Request submit bid samples to:            Anne-Marie Nadeau

University of Maine

5765 Service Building

Orono, Maine 04469

Sealed bid # _________

 

1.10      Submission:  A signed original plus two (2) copies of the bid must be received at the University Purchasing Department, 5765 Service Building, Orono, Maine 04469-5765, no later than 2:00 P.M. local time Wednesday, November 10, 2004, for a public opening.  Bidders are strongly encouraged to submit bids in advance of the due date to avoid the possibility of missing the 2:00 deadline due to unforeseen circumstances.  Vendors assume the risk of the methods of dispatch chosen.  The University assumes no responsibility for delays caused by any package or mail delivery service.  Postmarking by the due date WILL NOT substitute for receipt of bid.  Bids must be date and time stamped by the Purchasing Department on time to be considered.  In the event that the University is closed due to inclement weather at the time that a bid is due, the bid will be opened at the same time on the next day that the University is open.  Vendors may wish to call 207-581-SNOW  or

1-800-581-SNOW if the weather is bad, to learn if the University has closed.  Bids received after the due date and time will be returned unopened.  Additional time will not be granted to any single vendor, however, additional time may be granted to all vendors when the University determines that circumstances require it.  FAXED BIDS OR E-MAIL BIDS WILL NOT BE ACCEPTED.

 

1.11      Debarment:  Submission of a signed bid in response to this solicitation is certification that your firm (or any subcontractor) is not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any State or Federal department or agency. Submission is also agreement that the University will be notified of any change in this status.

 

1.12      Award Protest:  Bidders may appeal the award decision by submitting a written protest to the director of Purchasing within five (5) business days of the award notice, with a copy of the protest to the successful bidder.  The protest must contain a statement of the basis for the challenge.

 

 

2.0  CONTRACT TERMS

 

2.1        Assignment:  Neither party of the Contract shall assign the Contract without the prior written consent of the other, nor shall the Contractor assign any money due or to become due without the prior written consent of the University.

 

2.2        Cancellation of Contract:  The University reserves the right to cancel the contract with thirty (30) days written notice or to cancel contracts immediately if the contractor does not conform to the terms and conditions of the contract.  Cancellation does not release the Contractor from its obligation to provide goods or services per the terms of the contract during the notification period.

 

2.3        Contract Documents:  If a separate contract is not written, the contract entered into by the parties shall consist of the Request for Bids, the signed bid submitted by the Contractor, the specifications including all modifications thereof, and a purchase order or letter of agreement requiring signatures of the University and the Contractor, all of which shall be referred to collectively as the Contract Documents.

 

2.4        Contract Term:  The contract term shall be for a period of  one (1) year commencing upon January 1, 2005.   With mutual written agreement of the parties this contract may be extended for two (2) additional one-year periods. 

 

2.5        Contract Modification and Amendment:  The parties may adjust the specific terms of this contract (except for pricing) where circumstances beyond the control of either party require modification or amendment.  Any modification or amendment proposed by the Contractor must be in writing to the Purchasing Department.  Any agreed upon modification or amendment must be in writing and signed by both parties.

 

2.6        Contract Administration:  Larry Violette, Student Auxiliary Services Purchasing Manager shall be the University's authorized representative in all matters pertaining to the administration of this contract.

 

2.7        Contract Data:  The Contractor is required to provide the University with detailed data concerning the contract at the completion of each contract year or at the request of the University at other times.  The University reserves the right to audit the Contractor's records to verify the data.  This data may include, but is not limited to, dollar volume, items sold, services rendered, and commissions paid to the University.

 

2.8        Quantities:  The quantities shown on the bid form are approximate only. The contract shall cover the actual needs of the University throughout the term of the contract regardless of whether they are more or less than the quantities shown.  Additional items, not included in this bid may be purchased at times throughout the term of the contract.  Contractor must be able to provide a complete line of Food Service uniforms.

 

2.9        Payments:  Payment will be upon submittal of an invoice to the Purchasing Department by the Contractor on a net 30 basis unless discount terms are offered.  Invoice must include the purchase order number.

 

2.10      Bid Prices:  The bid shall be in the form of a firm price for each line item during the contract period.  The bid price shall include charges such as embroidery, shipping, insurance, and all other costs.  Charges not specified in the bid will not be honored.

 

2.11      Transportation Charges:  Quotations must be F.O.B. Destination. Prices quoted will be considered to include all charges for transportation, packaging, crates, containers, insurance, duty and brokerage charges, etc. necessary to complete delivery.

 

2.12      Delivery:  Delivery may be made via Contractor’s own delivery vehicles or by common carrier.  Delivery must be made to all Student Auxiliary Service locations below:

 

                        Wells Conference Center                        Stodder Commons

                        York Commons                                      Stewart Commons

                        Hilltop Commons                                   Memorial Union Marketplace

 

                  Additional locations may be added at any time throughout the term of the contract.

 

2.13      Packing Slips:  All charges must be prepaid and material delivered to the location specified.  Merchandise must be accompanied by delivery slip or packing list and the purchase order number.

 

2.14      Alterations:  Contractor shall be responsible for alterations as necessary when new and prior to use at no cost to the University.  University employees will be responsible for alterations and repairs after the garment has been used.

 

2.15      Ordering of Appropriate Sizes:  The University will state the required size needed at time of order.  Size will include inseam on pants, length of skirt, etc.  The University has or will purchase a sample of each garment, in a variety of sizes, to use in determining appropriate size needed for each employee.  For items that are similar (e.g. short-sleeve and long-sleeve shirts) one or the other will be purchased for this use.

 

2.16      Ordering:  The University will place orders on an as needed basis.  The quantities shown in section 4.1 indicate the approximate number of each garment purchased over a 12 month period.

 

2.17      Equal Opportunity:  In the execution of the contract, the Contractor and all subcontractors agree, consistent with University of Maine System policy, not to discriminate on the grounds of race, color, religion, sex, sexual orientation, national origin or citizenship status, age, disability or veterans status and to provide reasonable accommodations to qualified individuals with disabilities upon request.

 

2.18      Independent Contractor:  Whether the Contractor is a corporation, partnership, other legal entity, or an individual, the Contractor is an independent contractor.  If the Contractor is an individual, the Contractor's duties will be performed with the understanding that the Contractor is a self-employed person, has special expertise as to the services which the Contractor is to perform and is customarily engaged in the independent performance of the same or similar services for others.  The manner in which the services are performed shall be controlled by the Contractor; however, the nature of the services and the results to be achieved shall be specified by the University.  The Contractor is not to be deemed an employee or agent of the University and has no authority to make any binding commitments or obligations on behalf of the University except as expressly provided herein.  The University of Maine System has prepared specific guidelines to be used for contractual agreements with individuals (not corporations or partnerships) who are not considered employees of the System. 

 

2.19      Litigation:  This Contract and the rights and obligations of the parties hereunder shall be governed by and construed in accordance with the laws of the State of Maine.  The Contractor agrees that any litigation, action or proceeding arising out of this Contract, shall be instituted in a state court located in the State of Maine.

 

2.20      Parking Regulations and Use of Walkways:  The Contractor's vehicles and those of their employees working on campus, must be registered with the Department of Public Safety.  Unregistered vehicles on the University campus are subject to a parking violation ticket and/or towing off campus.  Contractor shall not be permitted to drive on walkways unless approved by the Contract Administrator and appropriate safety precautions are implemented.  Contractors are advised that parking and walkway rules/regulations are strictly enforced by campus police.  Towing will be at the Contractor's expense.  A copy of regulations can be obtained by calling Public Safety Parking Office at 581-4047.

 

2.21      Sexual Harassment:  The University of Maine is committed to providing a positive environment for all students and staff.  Sexual harassment, whether intentional or not, undermines the quality of this educational and working climate.  The University thus has a legal and ethical responsibility to ensure that all students and employees can learn and work in an environment free of sexual harassment.  Consistent with the state and federal law, this right to freedom from sexual harassment was defined as University policy by the Board of Trustees.

 

Failure to comply with this policy could result in termination of this contract without advanced notice.  Further information regarding this policy is available from the Director of Equal Opportunity, North Stevens Hall, 581-1226.

 

2.22      Smoking Policy:  The University of Maine System must comply with the "Work place Smoking Act of 1985" and MRSA title 22, 1541 et seq, "Smoking Prohibited in Public Places."  In compliance with this law, the University of Maine System has prohibited smoking in all University System buildings except in designated smoking areas.  This rule must also apply to all contractors and workers in existing University System buildings.  The Contractor shall be responsible for the implementation and enforcement of this requirement within existing buildings.

 

 

3.0  SPECIFICATIONS

 

3.1        Sizing:  Contractor must offer a full range of sizes including up to 5X.  If a specified item is not available in sizes up to 5X please offer an alternative garment that is similar to that specified but is available in the larger sizes; e.g. if item A is only available up to 3XL, please bid on the specified garment AND offer an alternative garment for sizes 4XL and 5XL.  For all items, if there are additional charges for larger sizes please include those costs in your bid.

 

3.2        Embroidery:  The University of Maine Dining Service Logo will appear on all garments as indicated (Embroidered) in section 4.1.  Employee name shall appear on all garments only when specified at time of order.  Two (2) logos will be used.  The official UMaine logo contains text and graphics and is three (3) color – light blue, dark blue, and white (must match PMS 292 and PMS 289), and will be used on most embroidered garments.  The logo for the baseball caps will be 1 color – white and contain text only.  Although the items in this contract are not for resale, we encourage the successful bidder to be a licensed manufacturer or licensed retailer for University of Maine products.  It is the responsibility of the bidder to inquire about the University's Trademark and Licensing Program for merchandise bearing University marks.  "Marks" means designs, trademarks, service marks, logo graphics, and symbols that have come to be associated with the University.    For more information, call the University Department of Marketing and Public Affairs, at 207-581-3759.  All logo designs must be approved by the University of Maine Department of Marketing and Public Affairs.

 

3.3        Guarantee:  All items must be durable and guaranteed under normal use for the purpose intended.  No irregular or factory seconds will be accepted.  Please state your warranty and your return/exchange policy (see section 4.5)

 

3.4        Cleaning:  All garments must be machine washable.  No garments requiring dry cleaning or ironing will be considered.  Recommended washing instructions must be include for each item on this bid.

 

3.5        For all items, where polyester/cotton blend is specified we will accept a small variance in percentages of each; (e.g. where 65% poly/35% cotton is specified, 60% poly 40% cotton will be acceptable).  Unless otherwise stated no garments of 100% cotton will be acceptable.

 

3.6  Garment Specifications:

 

      A.   Chef Coat – Long Sleeve:  Red Kap, Style 0420, or acceptable alternative. (Embroidered)  

            7 oz. Fine line twill Executive Chef coat, two rows of five French knotted cloth buttons, stand up collar, vented cuffs, double breasted front, thermometer pocket on left sleeve, generous armhole openings, underarm ventilation eyelets, 65% polyester/35% cotton. White.

 

      B.   Chef Coat – Hemmed to Short Sleeve:  Red Kap, Style 0420, or acceptable alternative.

            Same item as A except Hemmed to Short Sleeve.  (Embroidered)  

 

      C.   Modified Baggy Chef Pants:  Red Kap, Style 5360, or acceptable alternative.

              7.5 oz. Poplin Yarn Dyed, three inch wide elastic waistband w/drawstring, two front pockets, one back pocket, 65% polyester/35% cotton twill.  Black.

 

D.    Twill Cook/Uniform Pants – non pleated:  Red Kap, Style 2020, or acceptable alternative.

        Brass zipper front with snap or button closure, two front pockets, two back patch hip pockets, side elastic waist, 7 oz. 65% polyester/35% cotton blend.  Black

 

E.    Uniform Pants – double pleated:  Fashion Seal Style 62320, or acceptable alternative.

  Brass zipper front with snap or button closure, multi stitched back elastic waistband, double pleated front, quarter top pockets, button thru back patch pocket on left side, 65% polyester/35% cotton twill.  Black.

 

      F.   Men’s Pleated Industrial Pant – Red Kap Style PT32 or acceptable alternative.

Touchtext soft hand twill, relaxed fit, front & back pockets, jean style waistband with button closure.  8 oz. 65% polyester/35% cotton twill. Black.

 

      G.   Men’s Plain Front Industrial Pant – Red Kap Style PT30 or acceptable alternative.

            Same as item F except with plain front, no pleats.

 

      H.   Food Processing Shirt-Short Sleeve:  Red Kap 5010, or acceptable alternative.

4.7 oz. 65% polyester/35% cotton, 5 button closure, left chest pocket, square hemmed bottom. White

 

I.    Polo Shirt – Short Sleeve, Ash City Extreme 85015, or acceptable alternative, (Harvard Square #132 not acceptable) (Embroidered)  

3 Button placket, solid body with matching collar & cuffs, 60% cotton/40% polyester pique, preshrunk. Navy Blue.

 

     

J.    Golf Shirt – Long Sleeve, Tri Mountain 608 Champion, or acceptable alternative. (Harvard Square 117 not acceptable)  (Embroidered)  

8.2 oz. pique knit, 60% cotton/40% polyester, clean finished placket with 3 horn buttons, square hemmed bottom, double stitched seams.  Navy Blue.

 

K.   Women’s Skirt – Pleated:  Edwards Style 9270, or acceptable alternative. 

Below the knee length, elastic side waistband, zipper with button closure, 100% polyester, two side pockets, rear kick vent.  Black.  Women’s sizes, 4 thru 30.

 

      L.   Men’s Oxford Button Down Dress Shirt – Long Sleeve: Red Kap SS36, or acceptable alternative:  (Embroidered)  

4.25 oz. 65% polyester/35% combed cotton, button-down banded collar, seven buttons w/center pleat placket, tailored sleeve placket, two pleats, adjustable cuff, one hemmed pocket w/triangular stitched corners, box pleat back.  Light Blue and White.

 

      M.  Women’s Oxford Button Down Dress Shirt – Long Sleeve:  Red Kap SS37 or acceptable alternative:  (Embroidered)  

            Same as item N but womens style.

 

      N.   Men’s Oxford Button Down Dress Shirt-Short Sleeve: Red Kap SS46, or acceptable alternative:  (Embroidered)  

            Same as item N. except short sleeve.

 

      O.   Women’s Oxford Button Down Shirt-Short Sleeve:  Red Kap SS47, or acceptable alternative:  (Embroidered)  

            Same as item O, except short sleeve.

 

      P.   Apron-Bib Style:  Fame F33, or acceptable alternative.

7.5 oz. Ultra-durable 65% polyester/35% cotton twill, ProDura stain finish, no pockets, 2 piece slider adjustable neck, 23” wide,  28” in length, 21” back tie.  Navy and White.

 

      Q.   Apron – V Style Neck: Fame F23, or acceptable alternative.

7.5 oz. Ultra-durable 65% polyster/35% cotton twill, ProDura stain finish, tailored finished facing for upscale look, center divided patch pocket, snap closure neck adjustment.  Assorted Colors

 

      R.   Baseball Cap:  Yupoong Style 6364, or acceptable alternative.  (Embroidered – Text Only)  

Six panel-low profile with soft flexible lining, 100% cotton, adjustable strap, matching undervisor, eight rows of stitching on visor. Navy.

 

      S.   Toque-Traditional Chef Hat:  Red Kap HP60, or acceptable alternative.

            80% polyester/20% cotton twill, adjustable Velcro closure. Black.

 

      T.   Beret-Chef Hat, Petite:  Univogue 1701, or acceptable alternative.

            Small floppy blended fabric with soil release, Velcro closure. Black.


 

4.0  Bid Submittal

 

      Alternative Sizes:  If offering additional items for sizes up to 5XL, please provide detailed specifications and identify which item (A, B, C…) the alternative is for.

 

      Prices based on a unit price for each item and include embroidered Dining Service Logo.  See item “U” below for cost of embroidered employee name.

 

Quantities listed below are being provided for informational purposes only and will be used by the University to calculate bids results.  Quantities indicate the approximate number of each garment the University purchased over a 12 month period.  Purchases will be made on an as needed basis.

 

4.1  Pricing:

                                                ESTIMATED ANNUAL                                                                     PRICE FOR       STARTING       

ITEM DESCRIPTION                       PURCHASE                  UNIT PRICE            TOTAL PRICE         LARGER SIZES AT SIZE              BRAND          STOCK #

 

A.   Chef Coat – Long Sleeve (#0420)       55                    $                            $                            $                                                                                       

 

B.   Chef Coat – Short Sleeve (#0420)            192                   $                            $                            $                                                                                       

 

C.   Modified Baggy Chef Pant (#5360)           367                   $                            $                            $                                                                                       

 

D.   Twill Cook Pant  (no pleat) (#2020)           98                    $                            $                            $                                                                                       

 

E.   Uniform Pant (double pleated) (#62320)    105                   $                            $                            $                                                                                       

 

F.   Men’s Pleated Industrial Pant (#PT32)     42                    $                            $                            $                                                                                       

 

G.   Men’s Plain Front Industrial Pant (#PT30)   40                  $                            $                            $                                                                                       

 

H.   Food Processing Shirt (#5010)                67                    $                            $                            $                                                                                       

 

I.    Polo Shirt (#85015)                                364                   $                            $                            $                                                                                       

 

J.    Golf Shirt (#603)                               60                    $                            $                            $                                                                                       

 

K.   Women’s Skirt (#9270)                           12                    $                            $                            $                                                                                       

 

L.   Men’s Oxford Button Down Dress

      Shirt – Long Sleeve  (#SS36)                  104                   $                            $                            $                                                                                       

 

M.  Women’s Oxford Button Down

      Dress Shirt  - Long Sleeve (#SS37)          74                    $                            $                            $                                                                                       

 

N.   Men’s Oxford Button Down Dress

      Shirt – Short Sleeve (#SS46)                  257                   $                            $                            $                                                                                       


 

 

                                                ESTIMATED ANNUAL                                                                     PRICE FOR       STARTING       

ITEM DESCRIPTION                       PURCHASE                  UNIT PRICE            TOTAL PRICE         LARGER SIZES AT SIZE              BRAND         STOCK #

 

O.   Women’s Oxford Button Down Dress

      Shirt – Short Sleeve (#SS47)                  79                    $                            $                            $                                                                                       

 

P.   Apron – Bib Style (#F33)                        132                   $                            $                            $                                                                                       

 

Q.   Apron – V Style Neck (#F23)                  24                    $                            $                            $                                                                                       

           

R.   Baseball Cap (#6364)                             268                   $                            $                            $                                                                                       

 

S.   Toque-Traditional Chef Hat (#HP60)         36                    $                            $                            $                                                                                       

 

T.   Beret-Chef Hat, Petite (#1701)                 82                    $                            $                            $                                                                                       

 

U.   Embroidery:       Cost per garment for Employee Name:     $                           

 

4.2        Delivery:  Attach information detailing your shipping/delivery system (company owned vehicles, common carrier, etc.)

 

4.3        Leadtime ARO:  State your standard leadtime ARO:                                                                                                        

 

4.4        Additional Items:  Provide information on other Food Service garments that are available through your company, (section 2.8).  Catalogs are preferred.

 

4.5        Guarantee:  Provide information detailing your guarantee/exchange/return policy:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        

 

4.6        Washing Instruction:  Attach recommended washing instructions for each item if not individually tagged on the garment itself.

 

4.7        Company Representation:  Provide name and telephone number of the representative that would be responsible for handling our account:

 

                        Name:                                                                                                                                                  

                       

                        Title:                                                                                                                                                    

 

                        Address:                                                                                                                                              

 

                        City:                                                                 State:                                             Zip:                        

 

                        Telephone:                                                                                            Ext.                                               

 


 

4.8        References:  A list of three references is required to be submitted with your quotation.  These references should be agencies your firm has done business with in the past year on projects with a similar scope to this one

 

 

Company Name:____________________________________________________

 

Address:_________________________________________________________

 

                  City:__________________    State:______     Zip Code:________________

 

Contact Person:__________________________________________________

 

Phone Number: (        ) _____________ Fax Number: (        ) _____________

 

 

 

 

Company Name:____________________________________________________

 

Address:_________________________________________________________

 

                  City:__________________    State:______     Zip Code:________________

 

Contact Person:__________________________________________________

 

Phone Number: (        ) _____________ Fax Number: (        ) _____________

 

 

 

 

Company Name:____________________________________________________

 

Address:_________________________________________________________

 

                  City:__________________    State:______     Zip Code:________________

 

Contact Person:__________________________________________________

 

Phone Number: (        ) _____________ Fax Number: (        ) _____________