B12_BPA_Response_Form.pdf

Proposal Response Form

Roll Away Dumpster Supply and Service Blanket Purchase Agreement

Crab Orchard National Wildlife Refuge Complex

July 2023

Use of this form is required. Additional information can be provided as desired by vendors.

Business Name:

Business Address:

Business city/state/zip:

Business telephone:

Business email:

Primary contact person:

Is your business registered in SAM.gov? YES NO

If you are registered in SAM.gov, what is your Unique Entity ID?

Is your business able to service all Crab Orchard National Wildlife Refuge Complex entities (Crab

Orchard National Wildlife Refuge, Cypress Creek National Wildlife Refuge, Crab Orchard

Superfund Project)?

YES NO

If above answer is no, please specify which Complex entities your business is able to service:

Crab Orchard National Wildlife Refuge

Cypress Creek National Wildlife Refuge

Crab Orchard Superfund Project

Please mark which dumpster sizes your business is able to provide as part of this proposal, as well as how many you have in stock:

10 cubic yard 30 cubic yard

15 cubic yard 40 cubic yard

20 cubic yard Other:

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Pricing Information

Please complete the following pricing information for each dumpster size your business is able to provide as part of this Blanket Purchase Agreement. Please note that these prices will be effective for the term of the Blanket Purchase Agreement.

We will provide a cubic yard dumpster at a rate of $ for placement at

. This rate includes placement and haul away of up to tons, with tonnage in excess being charged at a rate of $ per ton.