1-RFP 2027-002 School Uniforms.pdf
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- School Uniform Program
- Solicitation number
- 2027-002
- Issued by
- Texas
About this file
This Request for Proposal (RFP 2027-002) is issued by Uplift Education Department of Procurement Services seeking qualified vendors to provide school uniforms for students across 19 campuses in the Dallas-Fort Worth area. The RFP solicits proposals for uniforms serving approximately 26,000 students in Pre-K through 12th grade, including polo shirts, Oxford shirts, pants, shorts, skirts, skorts, jackets, outerwear, PE uniforms, belts, accessories, and staff apparel, with campus-specific branding, colors, and designs. Uplift intends to award contracts to multiple vendors to ensure competitive pricing, supply continuity, service accessibility, and parent choice. The RFP was released October 15, 2026, with a question deadline of October 29, 2026, and proposal submission deadline of November 12, 2026 at 2:00 PM CST. A pre-proposal conference is not required. The proposal evaluation period runs November 16 through December 3, 2026, with an anticipated award date in December 2026. The contract term extends from March 1, 2027 through February 29, 2028, with two optional one-year renewals at Uplift Education's discretion. Uniforms must be available for fitting and purchase by May 31, 2027.
Pricing proposals must include all costs for goods and services, including base fees, unit pricing, labor and service charges, delivery and freight, implementation and setup fees, and optional services. Vendors must identify any costs excluded from proposed pricing. Evaluation criteria include purchase price (30 points), quality (20 points), fit to needs (25 points), reputation (10 points), vendor location/employment (10 points), and past relationship (5 points). Required services include campus-specific garment production with school logos via embroidery, online shopping portal capabilities, bilingual customer service, inventory management with minimum stock commitments beginning May 31, 2027, multi-channel customer support, 30-day return accommodations for damaged items, and quality control. Vendors must obtain liability insurance, provide proof of Automobile Liability and Workers' Compensation coverage, and comply with background check requirements for personnel with student contact. Uplift Education, a nonprofit organization, will provide tax-exempt documentation. Payment terms are net 30 days upon receipt of correct invoices referencing applicable purchase orders with sufficient detail of goods or services delivered.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Uplift Education Style-Guide.pdf | ||
| 4-Uplift Vendor Packet 2026 - Blank.pdf | ||
| 2-Uplift Uniform Vendor Pricing Response Sheet.xlsx | XLSX spreadsheet |
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REQUEST FOR PROPOSAL (RFP)
2027-002 – School Uniform Program
Project Title School Uniform Program
Solicitation / RFP No. 2027-002
Issuing Agency Uplift Education
Department Department of Procurement Services
Procurement Contact Darla Powell, Director of Procurement – dpowell@uplifteducation.org
RFP Release Date October 15, 2026 @ 10:00 AM CST
Pre-Proposal Conference Not Required
Deadline to Submit Questions October 29, 2026 @ 5:00 PM CST
RFP Closing / Submission Deadline November 12, 2026 @ 2:00 PM CST
Proposal Evaluation Period November 16 – December 3, 2026
Anticipated Award Date December, 2026
Period of Performance / Contract Term March 1, 2027 – February 29, 2028, w/ two 1-Yr Renewals
Solicitation Notice Uplift Education invites qualified proposers to submit proposals for the services, goods, or solutions described in this Request for Proposal. The selected proposer(s), if any, will be determined in accordance with the requirements of this solicitation and Uplift Education policies and procedures.
The Uplift Education Bonfire/EUNA portal is the designated submission method unless this solicitation expressly states another method. Proposers are responsible for ensuring that their proposal is received before the stated deadline. Late, corrupted, incomplete, or otherwise non-responsive submissions may not be considered.
Checklist and Submission Guidelines
☐ Read the entire RFP, including all attachments, specifications, terms and conditions, and addenda.
☐ Attend the pre-proposal conference, if applicable.
☐ Submit questions through the designated method before the question deadline.
☐ Review all issued addenda, Q&A, and other solicitation communications.
☐ Prepare the proposal in the required format and complete all required forms.
☐ Submit the proposal and required attachments through the designated Uplift Education submission portal.
Uplift Education | School Uniforms | 2027-002
1. Project Overview Uplift Education is soliciting proposals from qualified vendors to provide school uniforms for students across multiple campuses. The intent is to award contracts to multiple qualified vendors to ensure competitive pricing, supply continuity, service accessibility, and parent choice.
Uplift Education operates 19 campuses across the Dallas-Fort Worth area. Uniform requirements are not uniform network-wide: each campus sets its own uniform standard (styles, colors, and required items) within network-level guidelines, and campuses currently vary in their vendor arrangements — some campuses have an existing approved/preferred vendor relationship, while others do not currently designate a vendor and allow families to source uniforms independently. This RFP is structured to accommodate that variation: awarded vendors will form a pool from which individual campuses may select, rather than a single network-wide mandated vendor. Vendors should be prepared to support campus-specific branding, colors, and product mixes rather than a single standardized uniform package.
Uniform purchases will occur through two purchasing channels:
1. Individual Parent/Guardian Purchases – Direct purchase by families through vendor retail, website, or ordering portal.
2. School Network Purchases – Bulk or individual purchases made directly by schools/campuses via purchase order.
Award of a contract does not guarantee minimum purchase volume. Parent purchases are voluntary, and school purchases will be made at campus discretion.
2. Purpose and Instructions to Proposers Uplift Education is soliciting proposals from qualified and experienced firms to provide the goods and/or services described in this RFP. The purpose of this solicitation is to identify a qualified contractor or contractors capable of meeting the requirements stated herein.
Proposers are responsible for reviewing the entire solicitation package, including all instructions, specifications, scope of work, attachments, forms, terms and conditions, and addenda prior to submission. The proposal must be signed by an individual authorized to legally bind the proposer.
Pricing shall include all costs necessary to provide the proposed goods and/or services unless specifically excluded and identified in the proposal. Any exclusions, assumptions, exceptions, or additional charges must be clearly stated.
This solicitation is governed by the laws of the State of Texas and applicable federal, state, and local laws, rules, regulations, Uplift Education policies, and incorporated standard or special terms and conditions.
By submitting a proposal, the proposer certifies that its response is submitted in accordance with the solicitation requirements and without collusion or fraud. No commitment or contractual obligation exists until an agreement is fully executed by authorized representatives of the parties.
3. Bidding Documents and Solicitation Procedures
• Instructions to Proposers
• Scope of Work / Specifications
• Pricing Proposal / Pricing Sheet
• Period of Performance / Contract Terms
• Required Forms and Certifications
• Any Addenda issued during the solicitation period
Only written clarifications, corrections, or modifications issued by Uplift Education through an Addendum shall be binding. Proposers should not rely on verbal statements or informal communications as modifications to the solicitation.
4. Pre-Proposal Conference, Questions, and Communications If a pre-proposal conference is scheduled, proposers are encouraged or required to attend as stated on the cover page. Questions must be submitted through the designated procurement portal or other method identified in the solicitation by the stated deadline.
During the solicitation period, proposers shall direct project-related communications only to the designated Procurement Contact and/or Project Contact identified in this RFP. Uplift Education may issue responses to questions and clarifications through an Addendum or the designated solicitation portal.
5. Addenda Uplift Education may issue Addenda to clarify, correct, supplement, or modify the solicitation. All issued Addenda become part of the solicitation and, if applicable, the resulting contract. Proposers are responsible for reviewing and acknowledging all Addenda.
6. Proposal Information Requirements and Format Unless otherwise specified in the project-specific Scope of Work, proposals should be organized in the following sequence:
Section I – Executive Summary Provide a concise summary of the proposer’s understanding of the project, qualifications, proposed approach, and key differentiators.
Section II – Firm Qualifications and Experience Provide company profile, years in business, relevant experience, organizational structure, certifications, and experience with similar organizations or projects.
Section III – Implementation / Performance Approach Describe implementation, project management, communication, quality assurance, reporting, service levels, timelines, and performance monitoring, as applicable.
Section IV – Financial Proposal Complete the project-specific Pricing Proposal or Pricing Sheet. Identify all fees, charges, reimbursable expenses, optional services, and other costs.
Section V – References Provide at least three current or recent references for substantially similar work, unless the Scope of Work specifies another number.
Section VI – Conflicts of Interest / Disclosures Identify any actual, potential, or perceived conflicts of interest and provide required disclosures.
7. Required Forms and Certifications
☐ New Vendor Information / Application Form
☐ Bid / Proposal Certification
☐ Conflict of Interest Questionnaire (CIQ), if required
☐ Debarment, Suspension, and Ineligibility Certification
☐ Notification / Release of Criminal History, if applicable
☐ Insurance documentation, if required
☐ W-9 and other vendor registration documentation, as requested
☐ Any project-specific forms identified in the Scope of Work or solicitation attachments
8. Scope of Work and Performance Requirements Awarded vendors shall provide all labor, materials, equipment, ordering systems, customer service, fulfillment, and related services necessary to supply school uniforms, at the campus or campuses to which they are awarded.
Recommended structure:
A. Background and Objectives
Uplift Education of Texas is seeking a preferred provider of school uniforms for students, families, and staff beginning with the 2027–2028 school year.
The selected vendor will provide uniforms meeting Uplifts’ specified designs, colors, materials, and construction requirements.
The objective is to provide families with convenient purchasing options through retail locations and/or an online shopping portal, while providing value through cost, delivery options, customer service, and timeliness.
Projected enrollment is approximately 26,000 across the district, with campus specific uniforms. Please reference Attachment A for campus specific student enrollment and grade levels.
B. Required Goods and/or Services
Supply school uniform garments for Pre-K through 12th grade, including:
o Polo shirts with and without branding o Oxford shirts with and without branding o Shorts, skirts/skorts and pants, o Jackets / Outerwear with and without branding o PE uniforms o Belts / accessories o Staff Apparel
Provide campus specific garments in required colors, materials, sizes, fits, and school-approved designs.
Provide one-time setup costs for crest embroidery, screen printing, and school logos digitizing and any additional artwork as specified.
Manage the complete uniform process, including inventory forecasting, back to school readiness plan, minimum stock commitments, rush order capability, manufacturing, transportation, sales, distribution, customer service and resolutions, quality control, and collection of customer payments.
C. Detailed Specifications / Deliverables
Uniform tops must include the school logo, with embroidery using stitch or soft-seal application.
Outerwear must include the school logo, with an option to embroider the student's name.
Required products will vary by campus. (for campus specific detail see Exhibit 1)
Vendor must provide size-run and color-run samples, embroidery and screen-print samples, and color swatches.
Vendor must maintain a minimum inventory of garments throughout the year beginning May 31, 2027.
D. Service Levels and Performance Requirements
Vendor must be able to supply the required polo shirts; vendors unable to provide polos will not be considered for additional items.
All Uplift Education locations must be able to purchase orders no later than May 31, 2027.
Vendor must provide expedient, courteous, and high-quality customer service.
Bilingual staff shall be available to serve families.
Vendor must establish reasonable customer response times and support multiple communication methods, including phone, email, and website.
Vendor must accept exchanges for size/fit and returns for damaged items, with returns accommodated up to 30 days after the first day of school.
Uplift may conduct unannounced visits to evaluate storefront customer service.
E. Staffing / Personnel Requirements
Vendor must provide information regarding its company and key employees involved in the project.
Implementation and Transition Requirements Contract is scheduled to begin May 1, 2027, following an estimated March 31, 2027 acceptance date.
Vendor is responsible for all startup activities and associated costs, including planning, production, transportation, distribution, storage/storefronts, staff training, and equipment or technology investments.
Vendor should outline their processes from design through production.
Uniforms must be available for fitting and purchase by May 31, 2027.
Vendor must establish inventory and distribution processes capable of supporting families throughout the district.
F. Communication and Reporting
Vendor must provide customer service through multiple channels, including telephone, email, website, and potentially in-person sales/customer service.
Vendors should identify their expected customer response times.
Uplift will communicate the selected vendor to families as the district's preferred uniform provider.
Vendor must provide itemized receipts to families.
Vendor must communicate any issues affecting service, quality, or performance and is responsible for resolving customer service issues.
G. Quality Assurance / Acceptance Vendor is responsible for quality control and resolution of quality-related issues.
Products must meet applicable OSHA standards, and nonconforming products may be returned for correction or replacement at the vendor's expense.
Uplift may conduct unannounced storefront visits to evaluate service quality.
H. Technology / Data / Security Requirements, if applicable
Vendor must provide an online shopping portal/website through which families and staff can purchase uniforms.
Vendor may be required to invest in technology necessary to support the program; such startup costs are the vendor's responsibility.
Vendor must protect confidential information and comply with applicable student privacy requirements, including FERPA and HIPAA where applicable.
Upon contract termination, the vendor must return student records, documentation, and other Uplift information used, created, or controlled by the vendor.
Vendor must maintain confidentiality of Uplift's proprietary and confidential information.
I. Optional Services / Add-Ons, if applicable
School Rewards Program.
Online Shopping Portal.
On-site fitting days.
Optional student-name embroidery on outerwear.
Vendors may propose layaway and payment plans and multiple payment methods.
Vendors may propose incentive programs such as early buying incentives, discounts, rebates, and/or free uniforms.
In-person sales and customer service locations are encouraged as an additional service option.
9. Pricing Proposal Provide pricing and specifications for the following (PLEASE ENTER PRICING IN ATTCHMENT A):
Pricing should identify all costs necessary to perform the Scope of Work, including, as applicable:
SAMPLE PRICING SHEET – all pricing will be entered in the accompanying spreadsheet.
• Base / recurring fees
• Unit pricing
• Labor and service charges
• Delivery, freight, travel, or mobilization costs
• Implementation / setup fees
• Optional services
• Discounts or volume pricing
• Other fees or charges Proposers shall clearly identify any costs not included in the proposed pricing.
10. Period of Performance / Contract Term The term for this contract will be from the date of acceptance (estimated to be March 31, 2027) with a scheduled start date of May 1, 2027 - April 30, 2028, with the possibility of continuation of an additional three, one-year contract, at the discretion of Uplift Education.
Item Category Required Offered (Y/N) Notes
Polo Shirts with and without branding Yes
Oxford Shirts with and without branding Optional
Pants Yes
Shorts Yes
Skirts / Skorts Yes
Jumpers Optional
Sweaters with and without branding Optional
Jackets / Outerwear with and without branding Yes
PE Uniforms Optional
Belts / Accessories Optional
Staff Apparel Optional
11. Evaluation and Selection Uplift Education will evaluate responsive proposals using the criteria identified in the project-specific solicitation.
Evaluation may consider qualifications and experience, technical/service approach, compliance with requirements, pricing, references, implementation approach, and other factors relevant to the procurement.
Project-specific evaluation criteria and weights:
Evaluation Criterion Weight / Points Description
Purchase Price 30 the cost offered by the vendor for the goods and services
Reputation 10 The reputation of the vendor and the vendor’s goods and services
Quality 20 The quality of the vendor’s goods or services. Vendor is an authorized reseller of the proposed product
Fit to needs 25 Extent to which the goods or services meet the Network’s needs
Past relationship 5 The vendor’s prior relationship with Uplift Vendor location/employment 10 Vendor proximity to Uplift
Uplift Education may use multiple phases of evaluation, including initial review, clarification requests, demonstrations, presentations, interviews, finalist exercises, negotiations, or a Best and Final Offer (BAFO), if appropriate to the procurement.
12. Initial Review – Responsiveness and Responsibility Proposals may be reviewed for responsiveness to the solicitation and the proposer’s responsibility and ability to perform the resulting contract. A proposal may be excluded from further evaluation if required information, forms, pricing, certifications, or other mandatory elements are not submitted as required.
13. References Unless otherwise specified, provide at least three references for substantially similar services or projects. See attached form.
14. Substitutions / Exceptions / Alternatives Any proposed substitution, exception, assumption, or alternative must be clearly identified in the proposal. The proposer shall provide sufficient information for Uplift Education to determine whether the proposed alternative meets the solicitation requirements.
15. Insurance The successful bidder(s) shall procure and keep in full force and effect for the duration of the contract liability insurance that complies with all applicable Federal, State and local laws. The successful bidder(s) will provide a certificate of insurance evidencing proof of Automobile Liability and Workers’ Compensation insurance coverages.
Uplift will be provided with a Waiver of Subrogation and will be shown as the certificate holder. Please click on the link for required insurance documentation. (Vendor Application and Sample Insurance Information).
16. Subcontractors Proposers shall disclose proposed subcontractors and the portion of work each subcontractor will perform. The awarded Contractor remains responsible for the performance, quality, confidentiality, compliance, and timeliness of subcontracted work.
17. Personnel, Campus Access, and Background Checks When applicable, Contractor personnel with continuing duties and an opportunity for direct contact with students must satisfy Uplift Education’s applicable background check, fingerprinting, identification, and campus-access requirements before beginning or continuing work.
Contractors and employees of contractors providing services to school districts or charter schools must be fingerprinted before beginning or continuing work, if those persons have continuing duties related to the contracted services and the opportunity for direct contact with students. The specific rules that apply to contractors’ employees and applicants are separated by state law into two categories: (1) service contractors; and (2) certain public works contractors that provide engineering, architectural, or construction services (TEC §§ 22.0834, .08341). In the past, schools and contractors relied on the Clearinghouse to access and assess criminal history (Texas Government Code §411.097).
18. Data Security and Confidentiality Contractors may receive confidential information related to Uplift Education, its scholars, families, employees, campuses, operations, or vendors. Contractors shall protect confidential information and use it only for authorized purposes. Project-specific data security, privacy, retention, destruction, and secure file-transfer requirements should be inserted here when applicable.
19. Contract Administration Uplift Education will designate a Contract Manager or other authorized representative to administer and monitor performance under the resulting agreement. The Contract Manager may monitor deliverables, service quality, schedules, invoices, compliance, and other performance requirements.
20. Changes in Work Changes to the Scope of Work, contract amount, or contract time must be authorized in writing by an appropriately authorized Uplift Education representative through a contract amendment, change order, revised purchase order, or other approved written mechanism, as applicable.
21. Acceptance, Invoicing, and Payment Acceptance of goods or services will occur when Uplift Education confirms that the deliverables meet the applicable specifications, quality standards, and other requirements. Invoices must reference the applicable purchase order or contract and include sufficient detail to verify the goods or services provided. Payment terms will be governed by the resulting contract and Uplift Education’s applicable procedures.
Uplift shall pay invoices in 30 days. In order for Uplift to pay invoices in 30 days, the vendor’s invoice must be correct, and reflect the work or goods delivered to Uplift. The 30 days begin when Uplift has received a correct invoice reflecting the work or goods delivered. If Uplift receives an invoice that is not correct and/or reflective of work or goods that have been delivered, Uplift will request a corrected invoice, and the 30-day period will begin once the correct invoice has been received. All work described in the vendor invoice must have been delivered in compliance with the terms of the contract. Invoices shall be submitted monthly to Uplift for payment for the base payment amount, unless both parties agree to alternative arrangements based on project milestones. Each invoice submitted for payment shall include, at a minimum, the following information:
A. Name and address of the department for which services were provided.
B. Contact information of City staff who placed orders (name, phone number, department) C. Date of order or Service D. Detailed description of each service
E. Price goods or services (charges for all services covered by this contract are to be separately stated and explained F. Total cost of goods/services
Submitting invoices without the above information may cause delays in payment processing. Incorrect invoices or invoices sent to the wrong address will delay payment. Vendors who fail to follow this procedure risk having the contract with Uplift cancelled.
22. Taxes Uplift Education is a nonprofit organization. Applicable tax-exempt documentation will be provided upon request.
Proposers should identify any taxes or charges that they believe are applicable and not otherwise included in pricing.
23. Records and Audit The Contractor shall maintain accurate records supporting performance and invoicing under the contract for the period required by applicable law, regulation, funding requirements, and Uplift Education’s contract terms. Uplift Education may review or audit records as permitted by the agreement.
24. Compliance with Laws and Regulations The Contractor shall comply with all applicable federal, state, and local laws, ordinances, rules, regulations, licensing requirements, permits, and Uplift Education policies applicable to the work.
25. Conflict of Interest Proposers shall disclose actual, potential, or perceived conflicts of interest and complete all conflict-of-interest forms required by Uplift Education. No Uplift official or employee shall have any financial interest, direct or indirect, in any contract with Uplift, or be financially interested, directly or indirectly, in the sale to Uplift of any land, materials, supplies or services, except on behalf of Uplift as a board member or employee. Any violation of this section shall constitute malfeasance in office, and any Uplift board member or employee guilty thereof shall thereby forfeit Uplift board member’s or employee’s office or position with Uplift. Any violation of this section, with knowledge, express or implied, of the person or corporation contracting with Uplift shall render the contract involved voidable by the Chief Executive Officer or Board of Directors.
26. Disqualification / Non-Responsiveness Uplift Education may determine a proposal non-responsive or a proposer non-responsible when the proposal or proposer fails to satisfy material solicitation requirements, required documentation, responsibility standards, or applicable legal or contractual requirements.
27. Reservation of Rights Uplift Education reserves the right, subject to applicable law and policy, to accept or reject any or all proposals;
cancel or reissue a solicitation; request clarification or additional information; negotiate with proposers when permitted; waive minor irregularities; make an award to one or multiple contractors when stated or permitted; and take other actions allowed by the solicitation and applicable requirements.
28. Confidentiality and Public Information Any information deemed confidential shall be clearly noted as such on each page of the solicitation response. Uplift cannot guarantee it will not be compelled to disclose all or part of any public record under the Texas Open Record Act. Proposals will be opened by Uplift to avoid disclosure of contents to competing Respondents and kept secret and confidential during the solicitation process and prior to award. Respondents who include information in a proposal that is legally protected as trade secret or confidential shall clearly indicate the information which constitutes a trade secret or confidential information by marking that part of the proposal “trade secret” or “confidential” at the appropriate place. If a request is made under the Texas Open Records Act to inspect information designated as trade secret or confidential in a proposal, the Proposer shall, upon request, immediately furnish sufficient written reasons and information as to why the information designated as a trade secret or confidential should be protected from disclosure, for Uplift Education’s Attorney to present the matter to the Attorney General of Texas for final determination.
29. Termination The resulting contract may include termination provisions addressing termination for convenience, termination for cause/default, notice requirements, payment for accepted work, transition obligations, and other applicable remedies. Insert project-specific requirements here or incorporate the applicable Uplift Education standard contract terms.
30. Governing Law The resulting agreement will be governed by the laws of the State of Texas and applicable federal law, except to the extent otherwise required by law or expressly stated in the final agreement.
31. Indemnification The selected Proposer agrees to defend, indemnify and hold Uplift, its officers, agents and employees, harmless against any and all claims, lawsuits, judgments, costs, and expenses for personal injury (including death), property damage or other harm for which recovery of damages is sought, suffered by any person or persons, that may arise out of or be occasioned by the selected Proposer’s breach of any of the terms or provisions of the contract, or by any other negligent or strictly liable act or omission of the selected Proposer, its officers, agents, employees, or subcontractors, in the performance of the contract; except that the indemnity provided for in this paragraph shall not apply to any liability resulting from the sole negligence or fault of Uplift, its officers, agents, or employees and in the event of joint and concurrent negligence or fault of the selected Proposer and Uplift, responsibility, and indemnity, if any, shall be apportioned comparatively in accordance with the laws of the State of Texas, without waiving any governmental immunity available to Uplift under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this paragraph are solely for the benefit of the parties hereto and are not intended to create or grant any rights, contractual or otherwise, to any other person or entity.
The awarded Contractor shall maintain current contact information and respond to Uplift Education communications within the response time specified in the resulting contract or project-specific Scope of Work.
32. Commencement / Notice of Award The contract shall commence on the date stated in the executed agreement or other authorized notice to proceed.
Uplift Education will provide notice of award in accordance with applicable procurement procedures.
Uplift’s intent is to award this solicitation to multiple contractors, but Uplift reserves the right to award in the method that is most advantageous to Uplift. Uplift reserves the sole discretion to determine whether a solicitation response is responsive. Uplift reserves the right to reject any or all bids and to waive minor irregularities or discrepancies in any solicitation response as may be in the best interest of Uplift. Late bids will not be considered for the award.
34. Attachments / Exhibits
• Attachment A – Pricing Proposal / Pricing Sheet
• Attachment B – New Vendor Information / Application Packet
• Attachment C – Debarment, Suspension, and Ineligibility Certification
• Attachment D – W-9
• Attachment E – Reference Form
• Attachment F – Insurance Documentation, if required
• This Document: Required Forms and Proposal Certification
• Exhibit 1 – Insurance Documentation, if required
35. Proposer Certification By signing below, the undersigned certifies that the proposer has reviewed the solicitation and attachments, understands the requirements, and is authorized to submit the proposal on behalf of the firm.
Proposer / Company Name ____________________________________________
Authorized Representative ____________________________________________
Title ____________________________________________
Signature ____________________________________________
Date ____________________________________________
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