Attachment 02 - Price List Template.xlsx

XLSX spreadsheet 39 KB Posted

Attached to
Household and Whitegoods Rental - AUS
Solicitation number
FA523426Q0019
Issued by

About this file

This is a pricing template for submission in response to a Blanket Purchase Agreement (BPA) solicitation for household furniture and appliance rental services across Australia. Offerors must submit firm-fixed-price commercial rates in Australian Dollars (AUD), exclusive of Goods and Services Tax (GST), using either this Excel template or a vendor-created alternative containing equivalent informational elements. The template accommodates partial bidding, allowing vendors to submit pricing only for specific geographic regions (Canberra, Sydney, Brisbane, Darwin, Alice Springs, Perth, Melbourne, and Cairns) and item categories they propose to service. All pricing must remain valid and binding for a minimum of one year from BPA establishment. The template requires separate completion tabs for each geographic region with line items covering two product categories: White Goods (refrigerators, washing machines, clothes dryers, microwave ovens, and dishwashers in various capacity specifications) and Furniture (sofas, tables, beds, mattresses, and bedroom storage items). Pricing structure requires submission of weekly rental rates across three lease duration bands: 1-12 months, 13-35 months, and 36+ months.

In addition to rental rates, vendors must provide firm-fixed-price fees for delivery and assembly services (0-50 km radius per household), surcharges for deliveries exceeding 50 km (per additional kilometer), collection and disassembly fees at lease end, relocation fees within the same region, and optional after-hours or weekend surcharges. Each submission must include completed vendor information (company name, CAGE/DUNS identifier, point of contact details) and a signed and dated "Acknowledgement and Authorization" certification by an authorized company representative confirming pricing accuracy, authority to bind the organization, rate guarantee validity, and commitment to notify the Contracting Officer of any changes within 48 hours. Failure to include a signed certification will render the submission non-conforming and ineligible for evaluation.

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Instructions

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
Instructions to Offerors
1. Purpose and Formatting:
This workbook provides the mandatory informational elements and format for submitting firm-fixed-price commercial rates for the Household Furniture and Appliance Rental Blanket Purchase Agreement (BPA). Offerors may submit their pricing using this provided Excel template or on a vendor-created template, provided that the vendor template contains all of the same informational elements and is organized in a similar manner to this document.
2. Partial Bidding Permitted:
Offerors are not required to provide pricing for every geographic location or every item category. The Government encourages partial offers to maximize competition.
Geographic Tabs: Only complete the tabs for the specific geographic regions your company proposes to service.
Line Items: Within an active tab, you must enter a price for the items you wish to offer. For any line item you do not offer, you may leave the cell blank or enter "N/A" (Not Applicable). Any item not priced will be interpreted by the Government as "Not Offered."
3. Pricing Requirements:
All prices must be submitted in Australian Dollars (AUD), exclusive of Goods and Services Tax (GST).
All submitted pricing must remain firm and valid for a minimum of one (1) year from the date of BPA establishment.
Provide your standard monthly rental rates for all proposed items.
Provide your standard flat-rate fees for delivery, assembly, and extraction. If your company offers after-hours or weekend services for an additional fee, you must list these optional surcharges in the designated area.
4. Submittal Completeness and Certification:
To be considered for a BPA award, your quote submission must be complete. This requires that your pricing submission includes the completed Vendor Details section and a signed and dated "Vendor Acknowledgment and Certification of Pricing" block. Failure to include a signed certification from an authorized representative will render your quote non-conforming, and it will not be evaluated further.

Canberra, ACT

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
e.g., QLD/ACT/NSW/VIC/WAAfter-Hours / Weekend Surcharge (Optional)Per Household
ACKNOWLEDGEMENT AND AUTHORIZATION
By submitting this price list, the undersigned acknowledges and agrees that the rates provided herein establish the firm-fixed-price ceiling for all Call Orders placed against this Blanket Purchase Agreement (BPA) for the

designated geographic area. The pricing submitted shall remain valid for the duration of the ordering period unless a formal modification is submitted to and accepted by the Contracting Officer.

Furthermore, the undersigned confirms and certifies that they are a legally authorized representative of the Contractor possessing the requisite authority to bind the organization to these terms and rates.

Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Sydney, New South Wales

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
e.g., QLD/ACT/NSW/VIC/WAAfter-Hours / Weekend Surcharge (Optional)Per Household
ACKNOWLEDGEMENT AND AUTHORIZATION
By submitting this price list, the undersigned acknowledges and agrees that the rates provided herein establish the firm-fixed-price ceiling for all Call Orders placed against this Blanket Purchase Agreement (BPA) for the

designated geographic area. The pricing submitted shall remain valid for the duration of the ordering period unless a formal modification is submitted to and accepted by the Contracting Officer.

Furthermore, the undersigned confirms and certifies that they are a legally authorized representative of the Contractor possessing the requisite authority to bind the organization to these terms and rates.

Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Brisbane, Queensland

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
e.g., QLD/ACT/NSW/VIC/WAAfter-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Darwin, Northern Territory

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
Weekend and After-Hours Delivery SurchargePer Household
After-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Alice Springs, Northern Territo

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
After-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Perth, Western Australia

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
After-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Melbourne, Victoria

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
After-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

Cairns, Queensland

ATTACHMENT 02 - MASTER BPA PRICE LIST
Household and White Goods BPA
VENDOR INFORMATION
Company Name:[Insert Company Name]
CAGE / DUNS / Unique Entity ID:[Insert ID] (If Applicable)
Point of Contact Name & Title:[Insert POC Name and Title]
Email Address:[Insert Email]
Phone Number:[Insert Phone]

INSTRUCTIONS: Enter the firm-fixed-price in the 'Unit Price' column. If an item or duration is not offered, enter 'Not Offered' or 'N/A'.

Geographic Region SupportedItem CategoryItem DescriptionCapacity / Size SpecificationWeekly Rate (1-12 Mo) AUDWeekly Rate (13-35 Mo) AUDWeekly Rate (36+ Mo) AUDComments
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer200-299 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer300-399 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer400-499 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsRefrigerator with Freezer500-600 L
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine5.5-7.4 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine7.5-8.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsWashing Machine9.0-10.0 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer4.0-5.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer6.0-7.9 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsClothes Dryer8.0-9.5 kg
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsMicrowave OvenStandard
e.g., QLD/ACT/NSW/VIC/WAWhite GoodsDishwasherFreestanding
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa2 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofa3 Seater
e.g., QLD/ACT/NSW/VIC/WAFurnitureSofaModular (4+ Seater)
e.g., QLD/ACT/NSW/VIC/WAFurnitureCoffee TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureTV Unit / Entertainment UnitStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSide TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table2-4 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table4-6 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining Table6-8 Seat
e.g., QLD/ACT/NSW/VIC/WAFurnitureDining ChairPer Chair
e.g., QLD/ACT/NSW/VIC/WAFurnitureBuffet / SideboardStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Bed FrameStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureSingle MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing Single MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureDouble MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureQueen MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureKing MattressStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureBedside TableStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureChest of DrawersStandard
e.g., QLD/ACT/NSW/VIC/WAFurnitureWardrobeTwo Door Minimum
Geographic Region SupportedService DescriptionUnit Price (AUD Ex GST)UnitComments
e.g., QLD/ACT/NSW/VIC/WADelivery, Install & Assembly Radius - 0 to 50 kmPer Household
e.g., QLD/ACT/NSW/VIC/WASurcharge for Delivery > 50 kmPer Additional km
e.g., QLD/ACT/NSW/VIC/WACollection & Disassembly Fee (End of Lease)Per Household
e.g., QLD/ACT/NSW/VIC/WARelocation Fee (to new address in same region)Per Household
e.g., QLD/ACT/NSW/VIC/WAAfter-Hours DeliveryPer Household
After-Hours / Weekend Surcharge (Optional)Per Household
By signing and submitting this BPA Price List, the undersigned hereby certifies and acknowledges the following:
1. Authority: I possess the legal authority to bind the Contractor/Offeror to the pricing, terms, and geographic service areas proposed within this document.
2. Validity: The pricing provided herein is accurate, fair, and reasonable, and represents the Contractor's current commercial rates as of the date of submission.
3. Rate Guarantee: All submitted pricing shall remain valid and binding for 1 year ordering period, unless formally modified.
4. Notification of Changes: If there is any change to the Contractor's commercial rates or capability to service an awarded geographic area, the Contractor must notify the administering U.S. Government Contracting Officer(s) in writing within forty-eight (48) hours of said change. No price increases shall take effect without formal written modification and acceptance by the Contracting Officer.
Authorized Representative Name / Title: ___________________________________
Authorized Representative Signature: _______________________________________
Date of Submission: ____________________________________________________

File details come from the government source that posted it. Updated .