DOA-3428 Public or Legal Notice Order.docx

51 KB Posted

Attached to
Class 5 Legal/Public Notices: Rate Certification Program
Contract number
505ENT-M26-RATECERT-00
Issued by
Wisconsin

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This document is a State of Wisconsin Department of Administration (DOA) Public or Legal Notice Order form (DOA-3428) related to Statewide Contract 505ENT-M26-LEGALNOTIC-01. The form is a standard template used by the State Bureau of Procurement located in Madison, Wisconsin, for ordering public or legal notices to be published in newspapers.

The document is a blank order form designed to capture publication details for legal notices, including sections for newspaper information, agency details, publication dates, format specifications, and notice text. While the specific contract details are not fully completed in this document, it serves as an administrative tool for state agencies to place legal notices, with options to specify publication parameters such as insertion dates, ad sections, logo usage, and special instructions. The form allows for flexible notice placement across various newspaper classifications including general, employment, bid proposals, and public meetings.

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State of Wisconsin Department of Administration

s. 16.75 Wis. Stats.

DOA-3428 (R12/2015)

State Bureau of Procurement 101 E. Wilson Street, 6th Floor Madison, WI 53707-7867

Statewide Contract:

505ENT-M26-LEGALNOTIC-01

Public or Legal Notice Order Instructions: Tab to each section and complete the information indicated. Save a copy of the order form to your computer. Email or fax this form with your agency’s notice of publication. If ad proof is required, please indicate in the Special Instructions section.

1.TO: newspaper INFORMATION
No. of Pages to Fax including this page:
Newspaper Name
Newspaper Contact Name
Newspaper Contact Email Address
Newspaper Area Code & Phone
Fax
Address: Street or PO Box
City/State/Zip+4

2. FROM: AGENCY INFORMATION

State Agency Name
Billing Reference No. (Purchase Order / Account #)
Advertisement Contact Name
Advert. Contact Area Code & Phone
Advert. Fax
Billing Contact Person Name
Billing Contact Area Code & Phone
Billing Fax
Billing Address: Street or PO Box
Billing City/State/Zip + 4
3.PUBLICATION DATE(S)
Enter DAY(S) and DATE(S) advertisement should appear in the newspaper.
DAY
DATE (mm/dd/ccyy)
First Insertion
Second Insertion
Third Insertion
|_| Tear Sheet Required with Invoice
|_| Affidavit Required with Invoice

4. FORMAT

|_| Single column |_| Display |_| Other, specify

5. LOGO

|_| State Coat of Arms |_| None |_| Other, specify

6.PLACE AD IN FOLLOWING SECTION
These are generic classifications and may or may not appear in this newspaper. Contact the newspaper for a list of specific classifications.
|_| General
|_| Employment Ad
|_| Secretary of State
|_| Public Meeting Notice
|_| Bid / Proposals
|_| Construction Bids
|_| Other, specify
7.COMMENTS AND SPECIAL INSTRUCTIONS
Enter comments or special instructions below. This information will not be published in the newspaper.
8.TEXT
Enter the text of the notice or indicate “see attached.” Include the following at the top of each attached page: Agency name, Agency advertisement contact name, Agency advertisement contact area code and phone.

This document can be made available in alternate formats to individuals with disabilities upon request.

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