ESBD_453817_1757955202614_582-26-8941 RFB Fillable Form.pdf

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Page of TCEQ-20457 (Rev 11/2017)

REQUEST FOR BID

REQUEST FOR BID

AGENCY TO INVOICE

AGENCY TO INVOICE

TCEQ

TCEQ

AGENCY INFORMATION

AGENCY INFORMATION

CONTACT NAME:

CONTACT NAME:

CONTACT PHONE:

CONTACT PHONE:

CONTACT EMAIL:

CONTACT FAX:

DESTINATION OF GOODS:

DESTINATION OF GOODS:

TCEQ

TCEQ

BID DUE DATE/TIME

BID DUE DATE/TIME

BID NUMBER

BID NUMBER

The laws of the State of Texas must prevail on all solicitations.

BIDDER MUST SIGN BELOW

FAILURE TO MANUALLY SIGN WILL DISQUALIFY BID

Authorized Signature

Type or Print Name

Date The laws of the State of Texas must prevail on all solicitations. BIDDER MUST SIGN BELOW FAILURE TO MANUALLY SIGN WILL DISQUALIFY BID Authorized Signature Type or Print Name Date

● By signing this Bid, Bidder certifies that if a Texas address is shown as the address of the Bidder, Bidder qualifies as a Texas Bidder as defined in Rule 34 TAC Rule 20.32(68).

● By signing this Bid, Bidder agrees to comply with all TCEQ terms, conditions, and affirmations found here: Request for Bid TCEQ Terms and Conditions.

● By signing this Bid, Bidder agrees that TCEQ may take into consideration any information gained about a Bidder from the Texas Comptroller of Public Account (CPA) Vendor Performance Tracking System.

● By signing this Bid, Bidder certifies that it does not boycott Israel and will not do so during the term of the Order.

● By signing this Bid, Bidder certifies that Bidder is not a listed company under the Texas Government Code Sections 806.031, 807.051, or 2252.153 as engaged in business with Iran, Sudan, or a foreign terrorist organization.

By signing this Bid, Bidder certifies that if a Texas address is shown as the address of the Bidder, Bidder qualifies as a Texas Bidder as defined in Rule 34 TAC Rule 20.32(68).

By signing this Bid, Bidder agrees to comply with all TCEQ terms, conditions, and affirmations found here: Request for Bid TCEQ Terms and Conditions.

By signing this Bid, Bidder agrees that TCEQ may take into consideration any information gained about a Bidder from the Texas Comptroller of Public Account (CPA) Vendor Performance Tracking System.

By signing this Bid, Bidder certifies that it does not boycott Israel and will not do so during the term of the Order.

By signing this Bid, Bidder certifies that Bidder is not a listed company under the Texas Government Code Sections 806.031, 807.051, or 2252.153 as engaged in business with Iran, Sudan, or a foreign terrorist organization.

BIDDER MUST FILL IN THE FIELDS BELOW:

BIDDER MUST FILL IN THE FIELDS BELOW:

Vendor ID Number: * Name of Firm:

Street Address:

City, State, Zip:

Telephone Number:

Fax Number:

DUNS Number:

* An identification number is required to process payment for goods/services purchased against contract awards. The Federal Employers Identification number (EIN) will be used to establish a payee id number. Please also enter your Federal Employers Identification number below:

Every vendor MUST have an Employer Identification Number (EIN), prior to receiving payment under an awarded contract. This is being required in an effort to minimize identity theft. For information on obtaining your EIN, call the IRS at 800-829-4933 or visit their website at http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Employer-ID-Numbers-EINs

PREFERENCES

Check below to claim a preference under 34 TAC Rule 20.38. See Section 2.38 of the State of Texas Procurement Manual regarding preferences.

Delivery in _______ Days Cash Discount _______ % _______ Line Item Class-Item Description Qty Unit (ea, bx, unit) Make/Model Unit Price Extension Line Item Class-Item Description Qty Unit (ea, bx, unit) Make/Model Unit Price Extension For clarification of these specifications, please contact:

Name:

Email:

Phone:

The individual listed above may be contacted for clarification of specification(s) only. No authority is intended or implied that specification(s) may be amended or alternates accepted prior to bid opening without written approval of the Texas Commission on Environmental Quality.

Bidder is requested to provide the information below for the submitted bid; however, bidder is hereby advised that this point-of-contact will not be recognized as or accepted in lieu of the “authorized signature” requirement of bid:

Name:

Email:

Phone:

Fax:

8.2.1.4029.1.523496.503679 P&C Request for Bid Blank Form Nora Randall Request for Bid

PO Box 13087, MC 174 Austin, TX 78711-3087

12100 Park 35 Circle, Bldg A Austin, TX 78753