8.12 - Attachment G-12 (Task Order Form).doc

INVITATION FOR BIDS (IFB) No. B24005, On-call Remediation & Abatement Services Task Order Form: On-call Remediation & Abatement Services (IFB Attachment G-12)

TASK ORDER (TO) No.:

ORDERED BY (HA): _________________________ TELEPHONE: ____________ FAX: _______________

CONTRACTOR: ____________________________ TELEPHONE: ____________ FAX: _______________ WORK REQUESTED @ UNIT ADDRESS: ______________________________________________________ UNIT TYPE: ___-Bedroom(s) AGREED UPON: START DATE:________ COMPLETION DATE:__________

CONTRACTOR’S PROPOSAL & ACKNOWLEDGMENT OF TASK ORDER

Attach on Contractor’s form a full detail of all work to be completed.

*If applicable, attach a detailed listing of all materials/supplies to be charged, including:

(1) Description of each item;

(2) Quantity of each item;

(3) Purchase cost of each item;

(4) Agreed upon mark-up of each item (@ ____%);

(5) Total charge for each item;

(6) Calculated total for all materials/supplies.

Approved by [Agency]:

Signature Date Printed Name

Received and Acknowledged by [Contractor]:

Signature Date Printed Name

AGENCY’S EVALUATION OF CONTRACTOR’S WORK PERFORMANCE

1. Rate this Contractor’s work performance: SATISFACTORY ______ NOT SATISFACTORY ______

2. Justification regarding rating of Contractor’s work performance—JUSTIFICATION MUST BE COMPLETED IF RATED NOT SATISFACTORY. (Attach supplemental page if necessary).

Rated By:

Signature Date Printed Name HomeFront, MT