2-Attachment 1 Offer and Acceptance Form.pdf

Invitation for Bid Solicitation No.

BPM006038

Description:

Laboratory Testing Services

State of Arizona Department of Child Safety

Office of Procurement & Contracts 3003 N. Central Ave., 20th Fl.

Phoenix, AZ 85012

Solicitation Instructions Part 2

SECTION 2-D: Offer Forms, Attachment 1 Page 18 of 35 2

A v a i l a b l e o n l i n e a t : A P P . A Z . g o v

Attachment 1 Offer and Acceptance Form

TO THE STATE OF ARIZONA:

The Undersigned hereby offers and agrees to furnish the material, service or construction in compliance with all terms, conditions, specifications and amendments in the Solicitation and any written exceptions in the offer.

Avertest LLC dba Averhealth

Offeror company name Signature of person authorized to sign Offer Initials

2916 W. Marshall St, Suite A Mark Johnson, Chief Executive Officer

Address Printed name and title

Richmond, VA 23230 Lauren Berens

City | State | ZIP Contact name and title

27-3929226 LBerens@averhealth.com 804-508-6202

Federal tax identifier (EIN or SSN) Email Address Phone Number

CERTIFICATION: By signature in the above, Offeror certifies that it:

1. The submission of the Offer did not involve collusion or other anticompetitive practices.

2. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, State Executive Order 2009-9 or A.R.S. §§ 41−1461 through 1465.

3. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting contract and may be subject to legal remedies provided by law.

4. The Offeror certifies that the above referenced organization ___ IS/ _X_ IS NOT a small business with less than 100 employees or has gross revenues of $4 million or less.

ACCEPTANCE OF OFFER: State hereby accepts the initial Offer, Revised Offer, or Best and Final Offer, and which was dated below. The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor’s Offer as accepted by the State. The Contractor is cautioned not to commence any billable work or to provide any material or perform any service under the Contract until the Contractor receives the applicable purchase order, contract release document or written notice to proceed.

State’s Contract No. is: The effective date of the Contract is:

, Procurement Officer Contract awarded date

End of Attachment 1

MJ

https://procure.az.gov/bso/