AMENDMENT 1.pdf

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Attached to
ON CALL DECK REPAIR SPARTANBURG
Solicitation number
5400029930
Issued by
Spartanburg County, South Carolina

About this file

This is Amendment 1 to an Invitation for Bid issued by the South Carolina Department of Transportation (SCDOT) for on-call deck repair services in Spartanburg County. The solicitation encompasses a comprehensive range of bridge maintenance and repair services including silicon joint replacement, V-Seal joint replacement, epoxy overlay, elastomeric concrete joint repair, asphalt joint replacement, concrete/asphalt deck repair, slab leveling and void-filling, soil stabilization, temporary lane closures, pipe rehabilitation using Cured-in-Place Pipe (CIPP) technology in sizes ranging from 15 inches to 84 inches in diameter, pipe extensions, vacuum truck services, dewatering pumps, grouting services, traffic control, CCTV inspection, and associated repairs. The bidding schedule contains 55 line items with estimated quantities based on a five-year potential contract term, though actual quantities may vary depending on Spartanburg County's needs. The amendment clarifies that CIPP lining sizes have been expanded to accommodate pipes up to 84 inches in diameter and that UV light curing is an acceptable method for resin within liners. Offers must be submitted online by July 29, 2026 at 2:30 PM, with questions due by July 13, 2026 at 12:00 PM. Award will be announced on August 14, 2026.

The solicitation requires offerors to submit a signed cover page and acknowledge all amendments. Nonresident contractors are subject to South Carolina's 2% withholding tax requirement unless they register with the Department of Revenue and submit Form I-312, or qualify for an exemption. Contractors must also certify that no SCDOT Commission members have direct or indirect interests in the proposal and that all subcontractors, consultants, vendors, and suppliers comply with this requirement. All work is categorized under product category 91366 (Maintenance and Repair Bridges). The contract is available only through South Carolina's online procurement portal at procurement.sc.gov, and the procurement officer is Tamika Thomas, reachable at 864-241-1010, extension 6027.

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Other files

File Type Posted
Attachment G (Third-Party).pdf PDF
Attachment H Work Zone.pdf PDF
SOLICITATION.pdf PDF
Attachment D.pdf PDF
Attachment E.pdf PDF
Attachment F.pdf PDF

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SAP

State of South Carolina

Invitation For Bid

EXEMPT

AMENDMENT 1

Solicitation:

Date Issued:

Procurement Officer:

Phone:

E-Mail Address:

Mailing Address:

5400029930 07/09/2026

TAMIKA THOMAS

864-241-1010 EXT6027

ThomasTS@scdot.gov SCDOT Procurement Office 955 Park St, Room 101 Columbia, SC 29201

DESCRIPTION: *ON CALL DECK REPAIR SPARTANBURG

USING GOVERNMENTAL UNIT: SC Department of Transportation

SUBMIT YOUR OFFER ON-LINE AT THE FOLLOWING URL: http://www.procurement.sc.gov SUBMIT OFFER BY (Opening Date/Time): 07/29/2026 @ 14:30:00 (See "Deadline For Submission Of Offer" provision) QUESTIONS MUST BE RECEIVED BY: 07/13/2026 @ 12:00:00 (See "Questions From Offerors" provision) NUMBER OF COPIES TO BE SUBMITTED: one online CONFERENCE TYPE: Not Applicable

DATE & TIME:

(As appropriate, see "Conferences - Pre-Bid/Proposal" & "Site Visit" provisions)

LOCATION: Not Applicable

AWARD &

AMENDMENTS

Award will be posted on 08/14/2026. The award, this solicitation, any amendments, and any related notices will be posted at the following web address: http://www.procurement.sc.gov

You must submit a signed copy of this form with Your Offer. By signing, You agree to be bound by the terms of the Solicitation. You agree to hold Your Offer open for a minimum of thirty (30) calendar days after the Opening Date. (See "Signing Your Offer" provision.)

NAME OF OFFEROR

(full legal name of business submitting the offer)

Any award issued will be issued to, and the contract will be formed with, the entity identified as the Offeror. The entity named as the offeror must be a single and distinct legal entity. Do not use the name of a branch office or a division of a larger entity if the branch or division is not a separate legal entity, i.e., a separate corporation, partnership, sole proprietorship, etc.

AUTHORIZED SIGNATURE

(Person must be authorized to submit binding offer to contract on behalf of Offeror.)

DATE SIGNED

TITLE

(business title of person signing above)

STATE VENDOR NO.

(Register to Obtain S.C. Vendor No. at www.procurement.sc.gov)

PRINTED NAME

(printed name of person signing above)

STATE OF INCORPORATION

(If you are a corporation, identify the state of incorporation.)

OFFEROR'S TYPE OF ENTITY: (Check one) (See "Signing Your Offer" provision.)

___ Sole Proprietorship ___ Partnership ___ Other_____________________________

___ Corporate entity (not tax-exempt) ___ Corporation (tax-exempt) ___ Government entity (federal, state, or local)

COVER PAGE - ON-LINE ONLY (MAR. 2015)

mailto:ThomasTS@scdot.gov http://www.procurement.sc.gov/

AMENDMENTS TO SOLICITATION

(a) The Solicitation may be amended at any time prior to opening. All actual and prospective Offerors should monitor the following web site for the issuance of Amendments: www.procurement.sc.gov (b) Offerors shall acknowledge receipt of any amendment to this solicitation (1) by signing and returning the amendment, (2) by identifying the amendment number and date in the space provided for this purpose on Page Two, (3) by letter, or

(4) by submitting a bid that indicates in some way that the bidder received the amendment. (c) If this solicitation is amended, then all terms and conditions which are not modified remain unchanged.

QUESTIONS FROM OFFERORS - AMENDMENT (JUN 2017)

THE SOLICITATION IS AMENDED AS PROVIDED HEREIN. INFORMATION OR CHANGES RESULTING

FROM QUESTIONS WILL BE SHOWN IN A QUESTION-AND-ANSWER FORMAT. ALL QUESTIONS

RECEIVED HAVE BEEN REPRINTED BELOW. THE “STATE’S RESPONSE” SHOULD BE READ WITHOUT REFERENCE TO THE QUESTIONS. THE QUESTIONS ARE INCLUDED SOLELY TO PROVIDE A CROSS-

REFERENCE TO THE POTENTIAL OFFEROR THAT SUBMITTED THE QUESTION. QUESTIONS DO NOT

FORM A PART OF THE CONTRACT; THE “STATE’S RESPONSE” DOES. ANY RESTATEMENT OF PART OR ALL OF AN EXISTING PROVISION OF THE SOLICITATION IN AN ANSWER DOES NOT MODIFY THE

ORIGINAL PROVISION EXCEPT AS FOLLOWS: UNDERLINED TEXT IS ADDED TO THE ORIGINAL

PROVISON. STRICKEN TEXT IS DELETED. [02-2A097-1]

The following questions were received regarding this solicitation. Responses have been provided and changes have been made to section VIII. BIDDING SCHEDULE / PRICE-BUSINESS PROPOSAL. The deletion, correction, or added lines are in RED TEXT added to the original provision.

QUESTION 1:

CIPP lining line items only go up to 24". We can provide CIPP lining up to 84" diameter. Can this be changed?

SCDOT RESPONSE:

Change The bidding schedule has been revised to address this request.

Line item descriptions 0019–0028 have been corrected. Please refer to the revised bidding schedule for the changes (red strikethrough text has been removed).

Line items 0029, 0030, 0048, and 0049 have been deleted because they duplicated line items 0025–0028.

New line items 0050–0055 have been added to the solicitation to include additional CIPP lining sizes.

QUESTION 2:

Is UV light cured and acceptable method for this bid?

SCDOT RESPONSE:

Change: Yes. UV light is the curing method used for the resin within the liner.

VIII. BIDDING SCHEDULE / PRICE-BUSINESS PROPOSAL

BIDDING SCHEDULE

Note: All quantities are estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County. CIPP is Cured-in-Place Pipe.

Line Number Quantity Unit of Measure Unit Price Extended Price

0001 300 Foot

Product Catg.: 91366 - Maintenance and Repair Bridges

Item Description: Silicon joint replacement 1in wide or less

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County.

0002 800 Foot

Item Description: Silicon joint replacement greater than 1

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County

0003 200 Foot

Item Description: V-Seal 300 joint replacement

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0004 200 Foot

Item Description: V-Seal 400 Joint Replacement

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0005 200 Square foot

Item Description: Epoxy Overlay

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0006 50 Cubic foot

Item Description: Joint repair using Elastomeric Concrete

Tendering Text: Unknown depth greater than 2in. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County.

0007 400 Cubic foot

Item Description: Asphalt joint replacement

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0008 2,000 US pound

Item Description: Concrete/Asphalt deck

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

Internal Item Number: 8

0009 20 US pound

Item Description: Concrete/Asphalt deck repair

Tendering Text: Fibrecrete G. The above quantity is estimated for the five-year potential term of the contract.

Quantities may be depending on the needs of SPARTANBURG County.

Internal Item Number: 9

0010 8,000 US pound

Item Description: Slab leveling, under-sealing and

Tendering Text: Void-Alling. The above quantity is estimated for the five-year potential term of the contract.

Quantities may be more or less depending on the needs of SPARTANBURG County.

0011 1,500 US gallon

Item Description: Soil Stabilization

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0012 5 Each

Item Description: Temp lane closure/2 lane/2 way roadway

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0013 5 Each

Item Description: Temp lane closure, Multi-lane roadway

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0014 5 Each

Item Description: Lane closure shift, Multi-lane roadway

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0015 5 Each

Item Description: Temp lane closure, 2lane/2way roadway

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0016 5 Each

Item Description: Temp lane closure, Multi-lane roadway

Tendering Text: Night-time. The above quantity is estimated for the five-year potential term of the contract.

Quantities may be more or less depending on the needs of SPARTANBURG County.

0017 5 Each

Item Description: Lane closure shift, multi-lane roadway

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0018 10 Each

Item Description: Mobilization

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0019 200 Linear Foot

Item Description: 15in Pipe rehabilitation CIPP up to 50ft

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0020 300 Linear Foot

Item Description: 18in Pipe rehabilitation. CIPP up to 50ft

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0021 200 Linear Foot

Item Description: 24in Pipe rehabilitation. CIPP up to 50ft

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0022 200 Linear Foot

Item Description: 15in Pipe rehabilitation. CIPP

Tendering Text: Greater than 50 lft. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County.

0023 300 Linear Foot

Item Description: 18in Pipe rehabilitation. CIPP

Tendering Text: Greater than 50 lft. The above quantity is estimated for the five-year potential term of the

0024 200 Linear Foot

Item Description: 24in Pipe rehabilitation. CIPP

Tendering Text: Greater than 50 lft. The above quantity is estimated for the five-year potential term of the

0025 200 Linear Foot

Product Catg.: 91366 - Maintenance and Repair Bridges.

Item Description: 30in Pipe Rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner up to 50 lft. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of SPARTANBURG County.

0026 200 Linear Foot

Item Description: 36in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner up to 50 lft. The above quantity is estimated for the

0027 200 Linear Foot

Item Description: 42in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner up to 50 lft. The above quantity is estimated for the

0028 200 Linear Foot

Item Description: 48in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner up to 50 lft. The above quantity is estimated for the

0029 200 Linear Foot

Item Description: 30in Pipe Rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner greater than 50 lft. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of

0030 200 Linear Foot

Item Description: 36in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner up to 50 lft. The above quantity is estimated for the

0031 100 Linear Foot

Item Description: Extension of pipe 15in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0032 100 Linear Foot

Item Description: Extension of pipe 18in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0033 100 Linear Foot

Item Description: Extension of pipe 24in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0034 100 Linear Foot

Item Description: Extension of pipe 30in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0035 100 Linear Foot

Item Description: Extension of pipe 36in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0036 100 Linear Foot

Item Description: Extension of pipe 42in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the ne eds of SPARTANBURG County.

0037 100 Linear Foot

Item Description: Extension of pipe 48in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0038 80 Hours

Item Description: Vacuum truck

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0039 10 Each

Item Description: Dewatering pump 2in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0040 10 Each

Item Description: Dewatering pump 4in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0041 10 Each

Item Description: Dewatering pump 6in

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0042 200 US gallon

Item Description: Host pipe grouting (one part)

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0043 12 Each

Item Description: Temporary Traffic Control

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0044 60 Hours

Item Description: CCTV

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0045 200 US gallon

Item Description: Host pipe grouting (two part)

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0046 400 Linear Foot

Item Description: Joint Seals

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

Each

NO BID

NO BID

Item Description: Associated Repairs

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0048 200 Linear Foot

Item Description: 42in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner, greater than 50'. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of

0049 200 Linear Foot

Item Description: 48in Pipe rehabilitation. CIPP

Tendering Text: Cementitious/Geopolymer spray liner, greater than 50'. The above quantity is estimated for the five-year potential term of the contract. Quantities may be more or less depending on the needs of

0050 200 Linear Foot

Item Description: 54in Pipe rehabilitation. CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0051 200 Linear Foot

Item Description: 60in Pipe rehabilitation. CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0052 200 Linear Foot

Item Description: 66in Pipe rehabilitation. CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0053 200 Linear Foot

Item Description: 72in Pipe rehabilitation CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0054 200 Linear Foot

Item Description: 78in Pipe rehabilitation. CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

0055 200 Linear Foot

Item Description: 84in Pipe rehabilitation. CIPP

Tendering Text: The above quantity is estimated for the five-year potential term of the contract. Quantities

IX. ATTACHMENTS TO SOLICITATION SAP

ATTACHMENTS LIST [09-9002-1]

The following documents are attached to this solicitation:

Attachment A Important Tax Notice- Nonresidents Only Attachment B Offeror s Checklist Attachment C No SCDOT Commissioner Interest or Recent SCDOT Employee Interest Attachment D Non-Compliance Notice Attachment E Damage Claim Form Attachment F Notice of Damage to SCDOT Property Form Attachment G Damage Claim Form (Third-Party) Attachment H Work Zone Traffic Control Standard Drawings

ATTACHMENT A

IMPORTANT TAX NOTICE - NONRESIDENTS ONLY

Withholding Requirements for Payments to Nonresidents: Section 12-8-550 of the South Carolina Code of Laws requires persons hiring or contracting with a nonresident conducting a business or performing personal services of a temporary nature within South Carolina to withhold 2% of each payment made to the nonresident. The withholding requirement does not apply to (1) payments on purchase orders for tangible personal property when the payments are not accompanied by services to be performed in South Carolina, (2) nonresidents who are not conducting business in South Carolina, (3) nonresidents for contracts that do not exceed $10,000 in a calendar year, or (4) payments to a nonresident who (a) registers with either the S.C. Department of Revenue or the S.C.

Secretary of State and (b) submits a Nonresident Taxpayer Registration Affidavit - Income Tax Withholding, Form I-312 to the person letting the contract.

The withholding requirement applies to every governmental entity that uses a contract ("Using Entity").

Nonresidents should submit a separate copy of the Nonresident Taxpayer Registration Affidavit - Income Tax Withholding, Form I-312 to every Using Entity that makes payment to the nonresident pursuant to this solicitation. Once submitted, an affidavit is valid for all contracts between the nonresident and the Using Entity, unless the Using Entity receives notice from the Department of Revenue that the exemption from withholding has been revoked.

Section 12-8-540 requires persons making payment to a nonresident taxpayer of rentals or royalties at a rate of $1,200.00 or more a year for the use of or for the privilege of using property in South Carolina to withhold 7% of the total of each payment made to a nonresident taxpayer who is not a corporation and 5% if the payment is made to a corporation. Contact the Department of Revenue for any applicable exceptions.

For information about other withholding requirements (e.g., employee withholding), contact the South Carolina Department of Revenue at 1-844-898-8542 or visit the Department's website at: www.dor.sc.gov

This notice is for informational purposes only. This agency does not administer and has no authority over tax issues. All registration and withholding tax questions should be directed to the South Carolina Department of Revenue at 1-844-898-8542. Additional contact information can be found by visiting the Department's website at www.dor.sc.gov

PLEASE SEE THE "NONRESIDENT TAXPAYER REGISTRATION AFFIDAVIT INCOME TAX WITHHOLDING" FORM (FORM NUMBER I-312) LOCATED AT: www.dor.sc.gov

[09-9005-5] http://www.dor.sc.gov/

ATTACHMENT B

OFFEROR'S CHECKLIST

AVOID COMMON BID/PROPOSAL MISTAKES

Review this checklist prior to submitting your bid/proposal.

If you fail to follow this checklist, you risk having your bid/proposal rejected.

• DO NOT INCLUDE ANY OF YOUR STANDARD CONTRACT FORMS!

• UNLESS EXPRESSLY REQUIRED, DO NOT INCLUDE ANY ADDITIONAL BOILERPLATE CONTRACT

CLAUSES.

• REREAD YOUR ENTIRE BID/PROPOSAL TO MAKE SURE YOUR BID/PROPOSAL DOES NOT TAKE

EXCEPTION TO ANY OF THE STATE'S MANDATORY REQUIREMENTS.

• MAKE SURE YOU HAVE PROPERLY MARKED ALL PROTECTED, CONFIDENTIAL, OR TRADE

SECRET INFORMATION IN ACCORDANCE WITH THE INSTRUCTIONS ENTITLED: SUBMITTING

CONFIDENTIAL INFORMATION. DO NOT MARK YOUR ENTIRE BID/PROPOSAL AS CONFIDENTIAL,

TRADE SECRET, OR PROTECTED! DO NOT INCLUDE A LEGEND ON THE COVER STATING THAT

YOUR ENTIRE RESPONSE IS NOT TO BE RELEASED!

• HAVE YOU PROPERLY ACKNOWLEDGED ALL AMENDMENTS? INSTRUCTIONS REGARDING HOW

TO ACKNOWLEDGE AN AMENDMENT SHOULD APPEAR IN ALL AMENDMENTS ISSUED.

• MAKE SURE YOUR BID/PROPOSAL INCLUDES A COPY OF THE SOLICITATION COVER PAGE.

MAKE SURE THE COVER PAGE IS SIGNED BY A PERSON THAT IS AUTHORIZED TO

CONTRACTUALLY BIND YOUR BUSINESS.

• MAKE SURE YOUR BID/PROPOSAL INCLUDES THE NUMBER OF COPIES REQUESTED.

• CHECK TO ENSURE YOUR BID/PROPOSAL INCLUDES EVERYTHING REQUESTED!

• IF YOU HAVE CONCERNS ABOUT THE SOLICITATION, DO NOT RAISE THOSE CONCERNS IN

YOUR RESPONSE! AFTER OPENING, IT IS TOO LATE! IF THIS SOLICITATION INCLUDES A PRE-

BID/PROPOSAL CONFERENCE OR A QUESTION & ANSWER PERIOD, RAISE YOUR QUESTIONS

AS A PART OF THAT PROCESS! PLEASE SEE INSTRUCTIONS UNDER THE HEADING

"SUBMISSION OF QUESTIONS" AND ANY PROVISIONS REGARDING PRE-BID/PROPOSAL

CONFERENCES.

This checklist is included only as a reminder to help offerors avoid common mistakes.

Responsiveness will be evaluated against the solicitation, not against this checklist.

You do not need to return this checklist with your response.

ATTACHMENT C

NO SCDOT COMMISSIONER INTEREST OR

RECENT SCDOT EMPLOYEE INTEREST

As a condition precedent to the execution of this Agreement, the undersigned, who is an authorized representative of the CONTRACTOR/CONSULTANT certifies on behalf of the CONTRACTOR/CONSULTANT, that during the procurement and award of this Agreement, and as an ongoing obligation under this Agreement until the end of the contract period, CONTRACTOR/CONSULTANT represents and agrees to comply with the following provisions:

1. In accordance Section 23 of Act 40 of 2017 (now codified as Section 57-1-350(G) of the Code of Laws of South Carolina 1976, as amended):

a) No member of the SCDOT Commission has an interest, direct or indirect, in the proposal or bid submitted to SCDOT for this Project, during the member’s term of appointment and for one year after the termination of the appointment.

b) No member of the SCDOT Commission will have an interest, direct or indirect, in any contract, franchise, privilege, or other benefit granted or awarded by the Department relating in any way to this Project (through subcontractors, consultants, vendor, or suppliers) during the member’s term of appointment and for one year after the termination of the appointment.

CONTRACTOR/CONSULTANT hereby certifies that it and all of its consultants, sub- consultants, contractors, vendors, suppliers, employees and agents will comply with the above provisions.

CONTRACTOR/CONSULTANT

By:

(Signature)

Print Name:

Date: Its:

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