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Wisconsin Department of Administration
State Bureau of Procurement
DOA-3088 (R07/2012)
Simplified Bidding Record (Purchases over $5,000 through $50,000;
for printing, $50 through $50,000)
| Date (mm/dd/ccyy) |
| Agency/Requisitioning Unit |
Person Completing
Instructions: The agency will make a special effort to award to small businesses, veteran-owned businesses, disabled veteran-owned businesses, minority businesses, and work centers. Use this form to document transactions over $5,000 through $50,000 and attach to purchase order file copy. Generic specifications should be used when possible. If it is necessary to use a brand name to identify a level of quality, vendors must be informed that equivalent alternatives may be acceptable. The agency will be the sole determinater of equivalency. Alternate bids should be indicated. Successful bidder should be circled. Reasons for rejecting any bids should be noted. If a waiver of bidding is approved, indicate reasons.
**Code type to be used: MBE=Minority Business Enterprise (Certified) WC= Work Center (Certified)
DVB = Disabled Veteran-owned Business (Certified) Mary Hnelser
Requisition or Reference Number
AG-2014-17 Due: 10/2/13 @ 10AM
Method of Bidding
FORMCHECKBOX
Price Lists
FORMCHECKBOX
Written Quote
FORMCHECKBOX
Phone / Verbal
FORMCHECKBOX
Other (specify) via Email____________________________
| Q |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| U |
| Atlas Tag/Label |
| Type |
| Badger Tag/Label |
| Type |
| Badger Group |
| Type |
| BSI |
| Type |
A
| Item Number, Description |
| N |
| Phone |
| Phone |
| Phone |
| Phone |
| I |
| FEIN*** |
| FEIN*** |
| FEIN*** |
| FEIN*** |
Unit
Unit
Unit
| Y |
| Price |
| Total |
| Price |
| Total |
| Price |
| Total |
| Price |
| Total |
| Tag, Printed on RED, 110# index stock |
| Size: 6 1/2" x 3 1/8", 1/2" clipped corners |
| Ink: Black, Printed One Sided, 9/16" fiber- |
| board reinforced hole (front & back) on top of |
| QUANTITY: 1,000 / each |
| .17942 |
| 179.42 |
| .29224 |
| 292.224 |
| NO |
| RESPONSE |
| NO |
| RESPONSE |
| additional for shipping: |
| 11.00 |
| Other quantities available for contract |
| pricing, see bid document for more details. |
***FEIN (Federal Employer Identification Number) or Social Security Number (if no FEIN)
| Contact Person |
| sales@atlas-tag.com |
| Deb |
| Contact Date (mm/dd/ccyy) |
| 10/01/13 |
| 10/01/13 |
| 10/01/13 |
| 10/01/13 |
| Reply Date (mm/dd/ccyy) |
| 10/02/13 @ 8:27am |
| 10/01/13 @ 1:46pm |
Additional information (note the following as appropriate: bids rejected and why; preferences exercised; explain reason if less than 3 vendors were contacted; justify waiver of bidding):
- See Page 2 -
Simplified Bidding Record
DOA-3088 (R07/2012)
| Q |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| Vendor Name |
| Code |
| U |
| UW Print Shop |
| Type |
| Type |
| Type |
| Type |
A
| Item Number, Description |
| N |
| Phone |
| Phone |
| Phone |
| Phone |
Unit
Unit
Unit
| Y |
| Price |
| Total |
| Price |
| Total |
| Price |
| Total |
| Price |
| Total |
| unable to do |
| the reinforced |
***FEIN (Federal Employer Identification Number) or Social Security Number (if no FEIN)
| Contact Person |
| Dave Watts |
| Contact Date (mm/dd/ccyy) |
| 10/01/13 |
| Reply Date (mm/dd/ccyy) |
| 10/01/13 |
This document can be made available in alternate formats to individuals with disabilities upon request.