15 Attachment 11 - COSTARS Election to Participate Form.doc

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Attached to
Fish Treatment Chemicals
Solicitation number
6100054186
Issued by
Centre County, Terre Hill Borough, Pennsylvania

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This document is an "Election to Participate" form for the COSTARS program, which is a cooperative purchasing program administered by the Pennsylvania Department of General Services. If awarded a contract through the COSTARS program, the firm agrees to sell the awarded items/services at the same prices and/or discounts, and in accordance with the contractual terms and conditions, to registered COSTARS Members who elect to participate in the contract. The firm also agrees to pay an applicable Administrative Fee ($1500, or $500 for a Department of General Services Self-Certified Small Business, or $166 for a Department of General Services-verified Small Diverse Business) at the beginning of each contract year and upon each contract renewal date.

If the firm is a Department of General Services Self-Certified Small Business or Department of General Services-verified Small Diverse Business, they must submit a copy of their active Small Business Contracting Program certificate with their bid response.

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Revised 01-17-2017

COSTARS PROGRAM ELECTION TO PARTICIPATE

If awarded a Contract, our firm agrees to sell the awarded items/services at the same prices and/or discounts, and in accordance with the contractual terms and conditions, to registered COSTARS Members who elect to participate in the contract. Our firm also agrees to pay the applicable Administrative Fee ($1500, or $500 for a Department of General Services Self-Certified Small Business, or $166 for a Department of General Services-verified Small Diverse Business) at the beginning of each contract year and upon each contract renewal date.

If you are a Department of General Services Self-Certified Small Business or Department of General Services-verified Small Diverse Business, you must submit a copy of your active Small Business Contracting Program certificate with your bid response.

Corporate or Legal Entity Name

Signature/Date

Printed Name/Title

File details come from the government source that posted it. Updated .