-Amatrol Electrical Machines Learning Systems.pdf

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Purchasing Department

Address:

501 N Riverpoint Blvd.

Spokane, WA 99202

Request for Quote (RFQ)

Competitive Solicitation - Not an Order

RFQ No.: 2025-RFQ-E7

Title: Amatrol Electrical Machines Learning

Systems

Issue Date: July 3rd, 2025

Questions?

Reference the Project No. and contact the following RFQ Coordinator:

Esther M.

Buyer 2

Email:

CCS.Purchasing@ccs.spokane.edu

RESPONSE DEADLINE

NOTE: To be considered, responses to this competitive solicitation must be delivered to the address listed above by no later than the appointed date and time listed below:

DATE DUE (on, or before) July 14th, 2025

TIME DUE (on, or before) 4:00 P.M., PST

PROCUREMENT AUTHORITY

The Community Colleges of Spokane (hereinafter “SPOKANE COLLEGES” or “College”) is issuing this competitive solicitation pursuant to applicable federal and state laws including, RCW 28B.10.029(1)(c)(iii). This competitive solicitation implies no obligation on the part of

SPOKANE COLLEGES to make a purchase. SPOKANE COLLEGES reserves the right to cancel this competitive solicitation for any reason and may reject any or all responses, including portions or parts thereof for good cause, including, exceeding the funds budgeted for the procurement.

SPOKANE COLLEGES also reserves the right to waive all minor irregularities in the competitive solicitation process and in the proposals received.

This RFQ does not obligate the state of Washington or SPOKANE COLLEGES to contract for goods specified herein.

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Equipment Specifications

Item No. Description Qty Unit Price Ext Price

85-MT2B

Amatrol Electrical Machines Learning

Systems

DC Generators Learning System (Regular Banana Leads)

Requires 85-MT2 Basic Electric Machines Learning System, 208V /60Hz/3ph electrical, and PC. See amatrol.com/support for PC requirements.

Includes: (1) Resistive Load Unit and (1) Inductive Load Unit;

(1) 45047 Regular Banana Lead Set; (1) MB876 Student

Curriculum - Interactive PC-Based Multimedia; (1) CB876

Instructor's Guide; (1) KB876 Instructor's Resource Print CD;

(1) DB876 Installation Guide; (1) H19706 Student Reference

Guide.

85-MT2C

Alternator / Synchronous Motor Learning System (Regular

Banana Leads) Requires 85-MT2 Basic Electric Machines

Learning System, 45034 Synchroscope, 17539 Oscilloscope, 208V/60Hz/3ph electrical, and PC. See amatrol.com/support for

PC requirements.

Includes: (1) Capacitive Load Unit, (1) Alternator/Synchronous

Motor, (1) Synchronizing Switch and Light Unit, (1) 45044

Regular Banana Lead Set; (1) MB878 Student Curriculum -

Interactive PCBased Multimedia; (1) CB878 Instructor's Guide;

(1) KB878 Instructor's Resource Print CD; (1) DB878

Installation Guide; (1) H19706 Student Reference Guide.

45034 Synchroscope (Regular Banana Leads) Required for 85-MT2C.

Includes: (1) Synchroscope; (1) Regular Banana Lead Set

K17539 Oscilloscope Bench type oscilloscope with 5.6" color display, 50 MHz bandwidth, and signal generator. (Supplied by KES)

85-MT2D

Wound Rotor Motor Learning System (Regular Banana Leads)

Requires 85-MT2 Basic Electric Machines Learning System, 208V /60Hz/3ph electrical and PC. See amatrol.com/support for

PC requirements.

Includes: (1) Wound Rotor Speed Controller and (1) Wound

Rotor Motor; (1) 45065 Regular Banana Lead Set; (1) MB877

Student Curriculum - Interactive PC-Based Multimedia; (1)

CB877 Instructor's Guide; (1) KB877 Instructor's Resource

Print CD; (1) DB877 Installation Guide; (1) H19706 Student

Reference Guide.

Discount

Ship To:

Subtotal $ -

3939 Freya ST

Spokane , WA 99217-6805 Delivery (FOB) Sales Tax 9% $ - Grand Total $ -

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Proposals for new equipment only, no used or remanufactured equipment will be accepted.

No Alternate Items will be Accepted.

DELIVERY LOCATION: 3939 N Freya ST, Spokane, WA 99217-6805.

All Bid pricing is to be FOB Destination, freight prepaid and included to invoice to the destination(s) specified herein.

Warranty period? __________________

Nearest Service Center Location ___________________________

When can these items ship? _______________

Are You OMWBE Certified? ___________ yes __________ no

Does This Product Meet Any Green Certification Standards? ___________ yes __________ no

Do You Provide Early Payment Discount? ___________ yes __________ no

Prices quoted hereon will remain firm for ______ days. (Minimum 90 days required).

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RFQ Specifications

1. DEVIATIONS AND ALTERATIONS

The box selected in this subsection below by SPOKANE COLLEGES is the one that applies for this

RFQ – Will SPOKANE COLLEGES consider deviations or alternates?

No. SPOKANE COLLEGES will NOT consider deviations or alternates in responses to this RFQ.

2. ERRORS

Unit prices will be used as basis for any award and for making any corrections of this order in cases of error made by the respondent when typing or completing responses to this RFQ for computations, calculations, or extensions.

3. FREIGHT

Unless otherwise specified, prices are F.O.B. destination, freight prepaid and included.

4. INSPECTIONS

Goods furnished under this contract are subject to inspection and test by SPOKANE COLLEGES at times and places determined by SPOKANE COLLEGES. If SPOKANE COLLEGES finds goods furnished to be incomplete or not otherwise in compliance with proposal specifications, SPOKANE

COLLEGES may reject the goods and require Seller to either correct them without charge or deliver them at a reduced price, which is equitable under the circumstances. If the Seller is unable or refuses to correct such goods within a time deemed reasonable by SPOKANE COLLEGES, SPOKANE

COLLEGES may cancel the order in whole or in part. Nothing in this paragraph shall adversely affect

SPOKANE COLLEGES’s rights, including the rights and remedies under the Uniform Commercial

Code.

5. DEVIATIONS / NON-CONFORMANCE

Any units not conforming to the exact specifications and / or statement of work set forth in this RFQ may be rejected by SPOKANE COLLEGES. It shall be the responsibility of the successful respondent to conform with the requirements and to propose or offer a solution that meets the specifications, capabilities and performance requirements contained in this RFQ, unless this RFQ specifically indicates that deviations will be considered and, in such cases, where deviations have been specifically cited by the respondent and acceptance has been made by SPOKANE COLLEGES on the basis of the exception.

6. EVALUATION

The SPOKANE COLLEGES appointed end-user will evaluate performance of the goods and work intended by this RFQ for a period of up to 90-days following delivery or performance. If the goods and work are deemed unacceptable, the successful respondent agrees to either provide a replacement at no additional cost or cancel the agreement and remove/return the goods at no additional cost to

SPOKANE COLLEGES.

7. PRICE INCLUSIVE

The price(s) offered in the response submitted to this RFQ shall be inclusive of all costs and charges for boxing, packing, or crating. SPOKANE COLLEGES will not permit any additional costs or charges for boxing, packing, or crating unless otherwise specified by SPOKANE COLLEGES in a written agreement.

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8. COMPLIANCE WITH LAWS AND REGULATIONS

The Bidder, by acceptance of an order resulting from this Request for Quotation, warrants full compliance with all applicable local, state, or federal laws and regulations and agrees to indemnify and defend SPOKANE COLLEGES against any loss, cost, liability or damage by reason of Bidder's violation of this paragraph.

9. COMPLIANCE WITH TERMS

SPOKANE COLLEGES may at any time insist upon strict compliance with these terms and conditions, notwithstanding any previous custom, practice, or course of dealing to the contrary.

10. AWARD FACTORS

A contract awarded as a result of this RFQ will be awarded to the lowest responsible and responsive bidder subject to the preferences provided by law. Award of any contract resulting from this RFQ may be based on the considerations, requirements and criteria set forth in RCW 39.26.160 or RCW

39.04.350, all as further set forth in the Technical Specifications Section or Statement of Work Section of this RFQ.

A. Notwithstanding any provisions to the contrary in this RFQ, SPOKANE COLLEGES and each College

(SCC and SFCC) reserves the sole right to make a multiple award; or may make independent awards

(i.e., different vendors for each College); or may make split award potentially resulting in an award to more than one bidder. Any award of a contract shall be non-exclusive and if SPOKANE COLLEGES and the Colleges deem it to be in the best interest of SPOKANE COLLEGES and/or the Colleges awards may be made in any combination that best meets the needs of SPOKANE COLLEGES and the

Colleges.

B. The following additional considerations, requirements and criteria set forth in RCW 39.26.160(3):

i. Best value criteria including:

1. (a) Whether the response satisfies the needs as specified in this RFQ, including whether the response meets the delivery date requirements of this RFQ.

C. SPOKANE COLLEGES may, at its sole discretion, reject the response of any respondent who has failed to perform satisfactorily on a previous contract with SPOKANE COLLEGES or the State of

Washington - RCW 39.26.160(5).

D. Pursuant to RCW 39.26.160(6), after reviewing all submissions, SPOKANE COLLEGES may enter negotiations with the lowest responsive and responsible bidder in order to determine if the bid may be improved. An agency may not use this negotiation opportunity to permit a bidder to change a nonresponsive bid into a responsive bid.

E. Any items not specifically identified within this quote may be negotiated with successful bidder on an

“as needed” basis.

F. Prices quoted are to be all inclusive. No additional payments will be made for any fees, intents, affidavits, permits, licenses, bonds, insurance policies, drawings, engineering, materials, labor, equipment, tools, shipping, travel, parking, or any other type or any other nature. This quote shall be awarded on the basis of “ALL OR NOTHING.”

11.COMPLAINT PROCESS

Pursuant to RCW 39.26.170, the complaint process allows bidders to focus on the solicitation requirements and evaluation process and raise issues with these processes early enough in the process to allow SPOKANE COLLEGES to correct a problem before bids are submitted and time expended on evaluations. Complaints may be made only by vendors who intend to submit a response to the solicitation.

Complaints filed on the day solicitation responses are due shall be reviewed and considered if time permits. Complaints that do not follow these procedures shall not be considered.

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The procurement complaint process will meet the following minimum requirements:

1) Bidders will be given an opportunity to submit a complaint to the SPOKANE COLLEGES based on any of the following:

a) The solicitation unnecessarily restricts competition.

b) The solicitation evaluation or scoring process is unfair or flawed; or

c) The solicitation requirements are inadequate or insufficient to prepare a response.

2) Bidders will be allowed to submit complaints up to 5 business days prior to the bid response deadline.

Complaints must meet the following requirements:

a) Must be in writing.

b) Must be sent to the procurement coordinator, or designee.

c) Should clearly articulate the basis for the complaint.

d) Should include a proposed remedy.

3) The procurement coordinator or designee will respond to complaints in writing. The procurement coordinator will consider all available facts and provide a response to the bidder. The response will include the decision, how the review was conducted and the basis upon which a decision was made.

4) The response to complaints including any changes to the solicitation will be posted as an amendment on

WEBS.

5) The Purchasing Manager will be notified of all complaints and provided a copy of the response.

6) The complaint may not be raised again during the protest period.

7) The complaint process does not include an appeal process. This complaint procedure constitutes the sole administrative remedy available to vendors under this solicitation.

12. PROTEST PROCEDURE:

Pursuant of RCW 39.26.170, the protest process occurs after the bids are submitted and evaluated. This allows bidders to focus on the evaluation process to ensure its integrity and fairness. Protests can raise issues related to the evaluation process as set out in the solicitation or how the process was executed. This allows for evaluation process errors and problems to be corrected before a contract is executed. Protests that do not follow these procedures shall not be considered.

The protest process will meet the following requirements:

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1) After the announcement of the apparent successful bidder (ASB), bidders will be offered a debriefing upon written request.

2) Bidders will be given 3 business days after the ASB is announced to request a debriefing.

3) Bidders are required to participate in a debriefing as a prerequisite for submitting a protest.

4) Bidders will be given 5 business days after their debriefing to file a written protest.

5) The protest process will allow bidders an opportunity to submit a protest based only on the following:

a) A matter of bias, discrimination, or conflict of interest on the part of an evaluator.

b) Errors in computing the scores; or

c) Non-compliance with procedures described in the procurement document or SPOKANE COLLEGES protest process.

6) Protests are to be submitted to the SPOKANE COLLEGES Purchasing Manager.

7) A written response within 10 business days from receipt of the protest, unless additional time is needed.

The protesting bidder shall be notified if additional time is needed.

8) The final determination of the protest shall:

Find the protest lacking in merit and uphold SPOKANE COLLEGES’s action; or

Find only technical or harmless errors in SPOKANE COLLEGES’s acquisition process and determine

SPOKANE COLLEGES to be in substantial compliance and reject the protest; or

Find merit in the protest and provide SPOKANE COLLEGES options which may include:

-- Correct the errors and re-evaluate all proposals, and/or

-- Reissue the solicitation document and begin a new process, or

-- Make other findings and determine other courses of action as appropriate.

9) The protest decision is final. If a protesting bidder does not accept the protest response, the bidder may try to seek relief from superior court. If SPOKANE COLLEGES determines that the protest is without merit, 8 | P a g e

SPOKANE COLLEGES will enter a contract with the successful vendor. If the protest is determined to have merit, one of the alternatives noted in the preceding paragraph will be taken.

Upon receipt of a protest, a protest review will be held by SPOKANE COLLEGES. SPOKANE COLLEGESs

Purchasing Manager or an employee delegated by the Purchasing Manager who was not involved in the procurement will consider the record and all available facts and issue a decision within five (5) business days of receipt of the protest. If additional time is required, the protesting party will be notified of the delay.

In the event a protest may affect the interest of another Vendor that also submitted a proposal, such Vendor will be given an opportunity to submit its views and any relevant information on the protest to the RFQ

Coordinator.

13.General Terms and Conditions https://Spokane Colleges.spokane.edu/getattachment/About-

Us/Departments/Purchasing/Vendor-Resources/SPOKANE COLLEGES-General-Terms-and-

Conditions.pdf?lang=en-US https://ccs.spokane.edu/getattachment/About-Us/Departments/Purchasing/Vendor-Resources/CCS-General-Terms-and-Conditions.pdf?lang=en-US https://ccs.spokane.edu/getattachment/About-Us/Departments/Purchasing/Vendor-Resources/CCS-General-Terms-and-Conditions.pdf?lang=en-US https://ccs.spokane.edu/getattachment/About-Us/Departments/Purchasing/Vendor-Resources/CCS-General-Terms-and-Conditions.pdf?lang=en-US

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Submittal Instructions

Request for Quote - RFQ No.: 2025-RFQ-E7 - Amatrol Electrical Machines Learning Systems

1. Response Package: The response to this RFQ must consist of:

a. Signed copy of Submittal Instructions (Page 9)

b. Quote for each item listed (Page 2)

c. Completed and signed copy of Certifications and Assurances (Page 10-11)

d. Completed and signed copy of OWMBE Declaration Form (Page 12) Optional

e. Copy of Vendor’s W-9

Submit Response Package to Esther M. SPOKANE COLLEGES.Purchasing@Spokane Colleges.spokane.edu by 4

PM PST July 14th, 2025.

*If any part of the response packet is not included, submissions will not be considered.

2. Response Identification: Responses must clearly identify the project number, bid due date and time, title of the bid, and the responding entity’s name, address, area code and phone number and the name of the person to contact. It is the sole responsibility of respondents to ensure their responses are received. Each response received and accepted shall constitute an offer to sell the goods or services to SPOKANE COLLEGES as described in the technical specifications and offers shall be good for a period of one hundred twenty (120) days following the Response Deadline.

3. Response Package: Responses shall consist of completing, signing, and returning the pages identified in the Response

Package of this RFQ.

4. Submittals: It is the sole responsibility of the respondent to ensure that their submittal is in the possession of the

SPOKANE COLLEGES Purchasing Department by the appointed date and time. Respondents must submit a response to this RFQ by electronic copy only (a scanned .pdf document of the completed Response Package) sent by email attachment to the contact person listed on the front page of this RFQ document. SPOKANE COLLEGES shall assume no responsibility for any formatting or technical problems that may occur with submitting a response by email resulting in a submittal being received either late by the Purchasing Department or which cannot be opened, or which is lost or misrouted by SPAM filters.

5. Addenda: Clarifications given unofficially by SPOKANE COLLEGES (i.e., either orally or by email and by other than the SPOKANE COLLEGES Purchasing Department) during the competitive solicitation process to questions asked by respondents will be considered informal and unofficial and not binding on SPOKANE COLLEGES or the bidder. Should any discrepancies or omissions be found in the specifications, or doubt as to its meaning, respondents shall at once notify the RFQ Coordinator in writing. As deemed necessary by SPOKANE COLLEGES, the RFQ Coordinator will issue written instructions in the form of addenda to be posted or distributed on WEBS (Washington Electronic Business

Solution). SPOKANE COLLEGES shall not be held responsible for oral interpretations. All official clarifications or interpretations of the competitive solicitation documents will be by written addenda issued by the SPOKANE

COLLEGES Purchasing Department. All addenda issued shall be incorporated into the competitive solicitation document and any resulting contract or purchase order. It shall be the responsibility of the respondent to check the postings for the competitive solicitation as frequently as necessary to maintain awareness and knowledge of the requirements (including all addenda) of the competitive solicitation.

Printed Name of Company (Bidder):

Signature: Date

Printed Name Title mailto:CCS.Purchasing@ccs.spokane.edu

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Certifications and Assurances: Part 1

I/we make the following certifications and assurances as a required element of the proposal to which it is attached, understand that the truthfulness of the facts affirmed here and continuing compliance with these requirements are conditions precedent to the award or continuation of the related contract.

1. I/we declare that all answers and statements made in the proposal are true and correct.

2. The prices and/or cost data have been determined independently, without consultation, communication, or agreement with others for the purpose of restricting competition. However, I/we may freely join with other persons or organizations for the purpose of presenting a single proposal.

3. The attached proposal is a firm offer for a period of 120 days following receipt, and it may be accepted by the

Agency without further negotiation (except where obviously required by lack of certainty in key terms) at any time within the 120-day period.

4. In preparing this proposal, I/we have not been assisted by any current or former employee of the State of

Washington whose duties relate (or did relate) to this proposal or prospective contract and who was assisting in other than his or her official public capacity. Any exception1 (see footnote) to these assurances are described in full detail on a separate page and attached to this document with the following box checked if respondent includes an additional separate page: (this box to the left if not checked by respondent in their submittal will be interpreted to mean that an additional separate page is not included in their response).

5. I/we understand that SPOKANE COLLEGES will not reimburse me/us for any costs incurred in the preparation of this proposal. All proposals become the property of SPOKANE COLLEGES, and I/we claim no proprietary right of ideas, writings, items, or samples unless so stated in this proposal.

6. Unless required by law, the prices and/or cost data which have been submitted have not been knowingly disclosed by the Respondent and will not knowingly be disclosed by him/her prior to opening, directly or indirectly to any other Respondent or to any competitor.

7. I/we agree that submission of the attached proposal constitutes acceptance of the solicitation contents and the attached sample contract and general terms and conditions. If there are any exceptions to these terms, I/we have described those exceptions on a page attached to this document.

8. No attempt has been made or will be made by the Respondent to induce any other person or firm to submit or not to submit a proposal for the purpose of restricting competition.

9. Pursuant to RCW 39.26.160(4) and RCW 39.04.350(2), the Respondent hereby signs this statement in accordance with chapter 5.50 RCW verifying under penalty of perjury that the Respondent is in compliance with the responsible bidder criteria requirements set forth in this RFQ [i.e., RCW 39.26.160(2)(f) and/or RCW

39.04.350(1)(g)]. SPOKANE COLLEGES may award a contract in reasonable reliance upon such this sworn statement by the below, undersigned respondent.

10. In addition to the foregoing certifications and assurances, I certify that to the best of my knowledge and belief the information contained in this response submittal is accurate and complete and that I have the legal authority to commit this entity to a contractual agreement. I realize the final funding for any service is based upon annual budget amounts approved by SPOKANE COLLEGES.

Printed Name of Company (Bidder):

Signature: Date

Printed Name Title http://app.leg.wa.gov/RCW/default.aspx?cite=5.50

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Certifications and Assurances: Part 2

Contractor Certification

Wage Theft Prevention – Responsible Bidder Criteria

Washington State Goods & Services Contracts

Prior to awarding a contract, agencies are required to determine that a bidder is a “responsible bidder.”

See RCW 39.26.160(2) & (4). Pursuant to legislative enactment in 2017, the responsible bidder criteria include a contractor certification that the contactor has not willfully violated Washington’s wage laws.

See Chap. 258, 2017 Laws (enacting SSB 5301)

Procurement No.: ____________________

Procurement Solicitation Date: _______________, 20___

I hereby certify, on behalf of the firm identified below, as follows (check one):

☐ No Wage Violations. The firm has NOT been determined by a final and blinding citation and notice of assessment issued by the Washington Department of Labor and

Industries or through civil judgement entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters

49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.

OR

☐ Violations of Wage Laws. The firm has been determined by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, a provision of RCW chapters 49.46, 49.48, or 49.52 within three (3) years prior to the date of the above-referenced procurement solicitation date.

1. I hereby certify, under penalty of perjury under the laws of the State of Washington, that the certifications herein are true and correct and that I am authorized to make these certifications on behalf of the firm listed herein.

Firm Name: ___________________________________________________________

Name of Contractor/Bidder – Print full legal entity name of firm

By: _______________________________ _______________________________

Signature of authorized person Print Name

Title: _______________________________ Place: _______________________________

Title of person signing certificate Print City and State where signed

Date: _______________________________

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Declaration Form

Office of Minority and Women’s Business Enterprises (OWMBE)

Name of Business

Address of Business

City State Zip

Name of Owner Phone Number

The business meets the criteria for a (MBE) minority business enterprise.

"Minority business enterprise," "minority-owned business enterprise," or "MBE" means a small business concern, organized for profit, performing a commercially useful function, which is legitimately owned and controlled* by one or more minority individuals or minority business enterprises certified by OMWBE. The minority owners must be United States citizens or lawful permanent residents.

The business meets the criteria for a (WBE) women’s business enterprise.

"Women's business enterprise," "women-owned business enterprise," or "WBE" means a small business concern, organized for profit, performing a commercially useful function, which is legitimately owned and controlled* by one or more women or women's business enterprises certified by

OMWBE. The women owners must be United States citizens or lawful permanent residents.

The business meets the criteria for a (MWBE) minority women’s business enterprise.

"Minority women's business enterprise" or "MWBE" means a small-business concern, organized for profit, performing a commercially useful function, which is legitimately owned and controlled* by one or more minority women and is certified by OMWBE. The owners must be United

States citizens or lawful permanent residents.

The business meets the criteria for a (CBE) combination business enterprise.

"Combination business enterprise" means a small business concern organized for profit, performing a commercially useful function, that is fifty percent owned and controlled by one or more minority men or MBEs certified by the office and fifty percent owned and controlled by one or more nonminority women or WBEs certified by OMWBE. The owners must be United States citizens or lawful permanent residents.

The business meets the criteria for a (SEDBE) socially and economically disadvantaged business enterprise.

"Socially and economically disadvantaged business enterprise" or "SEDBE" means a small-business concern, organized for profit, performing a commercially useful function, which is legitimately owned and controlled* by one or more socially and economically disadvantaged individuals or socially and economically disadvantaged business enterprises certified by OMWBE. The socially and economically disadvantaged owners must be United States citizens or lawful permanent residents.

"Socially and economically disadvantaged individual" means a person who is a citizen or lawful permanent resident of the United States and who is:

(a) Found to be a socially and economically disadvantaged individual on a case-by-case basis by OMWBE; or

(b) A member of one of the following groups that are presumed to be socially and economically disadvantaged:

(i) Minority.

(ii) Women.

(iii) Any additional groups whose members are designated as socially and economically disadvantaged by the U.S. Small Business

Administration (SBA), at such time as the SBA designation becomes effective.

The business meets the criteria for a veteran owned business.

“Veteran Owned Business” means a small-business concern, organized for profit, performing a commercially useful function, which is legitimately owned and controlled* by one or more veteran(s) and is certified by the OMWBE. The owners must be United States citizens or lawful permanent residents.

The business does meet one or more of the previously listed criteria but is not certified by OMWBE. If checked, indicate below all the categories the business would qualify for:

The business does not meet any of the previously listed criteria.

Signature Date

Printed Name of Signer Printed Title of Signer