doa-3070dwd2019.doc

State of Wisconsin

Wis. Statutes s.16.75

DOA-3070 (R05/2014)

BIDS MUST BE SEALED AND ADDRESSED TO:

FORMCHECKBOX

Remove from bidder list for this commodity/service. (Return this page only.)

AGENCY ADDRESS: Department of Administration

Bureau of Procurement

(101 East Wilson Street, 6th Floor, 53703)

P.O. Box 7867

Madison, WI 53707-7867 Bid envelope must be sealed and plainly marked in lower corner with due date and Request for Bid # _28312-MS. Late bids will be rejected. Bids MUST be date and time stamped by the soliciting purchasing office on or before the date and time that the bid is due. Bids dated and time stamped in another office will be rejected. Receipt of a bid by the mail system does not constitute receipt of a bid by the purchasing office. Any bid which is inadvertently opened as a result of not being properly and clearly marked is subject to rejection. Bids must be submitted separately, i.e., not included with sample packages or other bids. Bid openings are public unless otherwise specified. Records will be available for public inspection after issuance of the notice of intent to award or the award of the contract. Bidder should contact person named below for an appointment to view the bid record. Bids shall be firm for acceptance for sixty (60) days from date of bid opening, unless otherwise noted. The attached terms and conditions apply to any subsequent award.

REQUEST FOR BID

December 3, 2018; end of day fillin "Date and time"

BIDDER (Name and Address)

Name (Contact for further information)

Marcy Schmelzer

Phone

608/266-1625 Date

November 9, 2018

Quote Price and Delivery FOB

Madison, Wisconsin fillin "F.O.B /Destination"

( Fax bids are accepted

( Email bids are accepted

Item

No.

Quantity and Unit

Per Unit Total

Faithful Performance Blanket Bond covering all employees of the Dept. of Workforce Development in the amount of $500,000 per occurrence with a $5,000 deductible

Three-year premium payable in advance

Public Official Bond for the Treasurer of the Unemployment Reserve Fund of the Job Service Division of the Dept. of Workforce Development, State of Wisconsin, as required by Section 108.16(4) of the Wisconsin Statutes in the amount of $500,000 (Statutes limit premium cost to not exceed one-fourth of one percent, per year, of the amount of the bond.)

Name of Insuring Company:

FORMCHECKBOX

We claim minority bidder preference [Wis. Stats. s. 16.75(3m)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Minority Business Enterprises. Bidder must be certified by the Wisconsin Supplier Diversity Program. If you have questions concerning the certification process, contact the Wisconsin Supplier Diversity Program, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53703, (608) 267-9550. Does Not Apply to Printing Bids.

FORMCHECKBOX

We claim disabled veteran owned business bidder preference [Wis. Stats. s. 16.75(3m)(b)(3)]. Under Wisconsin Statutes, a 5% preference may be granted to CERTIFIED Disabled Veteran Owned Businesses. Bidder must be certified by the Wisconsin Supplier Diversity Program. If you have questions concerning the certification process, contact the Wisconsin Supplier Diversity Program, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53703, (608) 267-9550. Does Not Apply to Printing Bids.

FORMCHECKBOX

We are a work center certified under Wis. Stats. s. 16.752 employing persons with severe disabilities. Questions concerning the certification process should be addressed to the Work Center Program, State Bureau of Procurement, 6th Floor, 101 E. Wilson St., Madison, Wisconsin 53702, (608) 266-2605.

Wis. Stats. s. 16.754 directs the state to purchase materials which are manufactured to the greatest extent in the United States when all other factors are substantially equal. Materials covered in our bid were manufactured in whole or in substantial part within the United States, or the majority of the component parts thereof were manufactured in whole or in substantial part in the United States.

FORMCHECKBOX

Yes FORMCHECKBOX No FORMCHECKBOX Unknown

In signing this bid we also certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit a bid; that this bid has been independently arrived at without collusion with any other bidder, competitor or potential competitor; that this bid has not been knowingly disclosed prior to the opening of bids to any other bidder or competitor; that the above statement is accurate under penalty of perjury.

We will comply with all terms, conditions and specifications required by the state in this Request for Bid and all terms of our bid.

Name of Authorized Company Representative (Type or Print)

Title

Phone

Fax

Signature of Above

Date

E-mail

This form can be made available in accessible formats upon request to qualified individuals with disabilities.