Exhibit I - Application Update Form.pdf

29 KB Posted

Attached to
Traffic Engineering Data Count Services
Solicitation number
ITQ 3514T02
Issued by
Crawford County, Pennsylvania

About this file

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This document is an Application Update Form for a state and local contract opportunity. The form allows a contractor to request changes to their qualifications, such as adding or deleting districts they are approved to provide services in. The contractor must sign and return the form to authorize any changes. All other contract terms and conditions remain in full force and effect. The form does not provide details on the specific products, services, project overview, quantities, response dates, award dates, or contract term. It is focused solely on the process for a contractor to update their approved district qualifications under the existing contract.

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EXHIBIT I

APPLICATION UPDATE FORM

APPLICATION UPDATE FORM

Contractor’s Name and Address (as shown on the original contract)

Contract Number: ___________________________

Federal Identification Number: ______________________________

SAP Vendor Number: ________________________

INSTRUCTIONS: Indicate what changes are being requested by checking each appropriate block below and following the specific instructions for each. Authorized Contractor signatory must sign and return this page and any other modified pages. All other terms and conditions not changed remain in full force and effect.

To Add a District(s): Indicate which additional District(s) that you are attempting to qualify for by placing an “X” next to the District(s) in the table below.

To Delete a District(s): Indicate which District(s) (for which you are currently qualified) you would like to delete by placing an “X” next to the District(s) in the table below.

For any other changes, contact the Issuing Officer established in Part II, paragraph B, of the ITQ contract.

I certify that the above statements and those on the attachments are true and complete and that I will not accept traffic engineering data count services from the Department concerning services in which I have an undisclosed past, present or contemplated interest.

Signature: Contractor’s Authorized Signatory Title: Date:

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