ITB_Event 178 Backhoe Loaders.docx

STATE OF IDAHO

DIVISION OF PURCHASING

FOR

IDAHO TRANSPORTATION DEPARTMENT

Invitation to Bid (ITB) Event 178

ITD Backhoe Loaders

Date of Issuance: 12/27/2023

TABLE OF CONTENTS

ITB Administrative Information

ITB Lead:

Jonathan Gray, Buyer Idaho Division of Purchasing 650 W. State St. Room 100 Jonathan.gray@adm.idaho.gov 208-332-1615

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PURPOSE

The State of Idaho Department of Transportation (ITD), through the Idaho Division of Purchasing (DOP), is requesting Bids from qualified Vendors for the purchase of eleven (11) Backhoe Loaders in accordance with the specifications provided below.

GENERAL INFORMATION, solicitation instructions and standard terms and conditions This Solicitation is issued by the state of Idaho (the “State”) via IPRO: (IPRO LOGIN). The ITB Lead is the only contact for this Solicitation. All correspondence regarding this ITB shall be in writing. In the event that it becomes necessary to revise any part of this ITB, amendments will be posted at IPRO. It is the responsibility of the Bidder to monitor IPRO for any updates or amendments. Any oral interpretations or clarifications of this ITB shall not be relied upon. All changes to this ITB must be in writing and posted at IPRO to be valid. Alternate Bids are not allowed.

INQUIRIES

Questions or other correspondence must be submitted in writing to the ITB Lead listed below. QUESTIONS MUST BE RECEIVED BY 11:59:59 P.M. Mountain Time ON DATE 01/4/2024. Written questions must be submitted using Attachment 1, Bidder Questions. Official answers to all written questions will be posted on IPRO as an amendment to this ITB.

ITB Lead: Jonathan Gray Phone: 208-3321615 E-mail: Jonathan.Gray@adm.idaho.gov

Any questions regarding the State of Idaho Standard Contract Terms and Conditions found at (Contract Terms and Conditions) must also be submitted in writing, using Attachment 1, Bidder Questions, by the deadline identified in the ITB Administrative Information. The State will not consider proposed modifications to these requirements after the date and time set for receiving questions. Questions regarding these requirements must contain the following:

1. The rationale for the specific requirement being unacceptable to the party submitting the question (define the deficiency).

2. Recommended verbiage for the State’s consideration that is consistent in content, context, and form with the State’s requirement that is being questioned.

3. Explanation of how the State’s acceptance of the recommended verbiage is fair and equitable to both the State and to the party submitting the question.

Bids which condition the Bid based upon the State accepting other terms and conditions not found in the ITB, or which take exception to the State’s terms and conditions, will be found non-responsive, and no further consideration of the Bid will be given.

BACKGROUND

Idaho Transportation Department is looking to purchase Backhoe Loaders for various road projects throughout the state.

SPECIFICATIONS

These specifications are the minimum mandatory specifications that your Bid must meet in order for the State to consider your Bid for award. Restate each specification listed in this section, followed by your response demonstrating that your Bid meets or exceeds the required specifications; provide model, part #, or description, as appropriate. (Attachment 2)

QUANTITY

Eleven (11) backhoe Loaders are needed for the state of Idaho to be delivered to the locations below.

(Section 15)

COST

Provide your fully burdened Total Cost on the Bid Schedule (Attachment 4).

BILLING PROCEDURE

The Contractor must provide a signed invoice upon Agency acceptance of each line item. The invoice must be submitted no later than thirty (30) calendar days after delivery. No invoice will be accepted or paid without receipt of required documentation. Invoices submitted without the required reports/documentation] will be returned to the Contractor for resubmission.

The Contractor must provide the following information with each invoice:

Invoices and reports are to be submitted to:

Agency Contact Person: TBD Agency Name: Idaho Transportation Department Address:

SUBMISSION REQUIREMENTS

9.1 Required Bid Submission Items

Your Bid Submission must consist of the following:

Bid Schedule Provide your cost information on Attachment 2, Bid Schedule, below. Do not submit your Bid on any other form. Submitting your Bid on a form different than the Bid Schedule may cause your Bid to be rejected as non-responsive.

State of Idaho Signature Page The State of Idaho Signature Page must be completed and submitted as part of your Bid. The State of Idaho Signature Page is attached in IPRO.

9.2 Bid Submission Methods

Bids must be submitted electronically via IPRO. Do not fax or e-mail your Bid. Your Bid must be received at the Division of Purchasing by the date and time specified on the IPRO header document. The official time, for bid closing purposes, is the Division of Purchasing’s time clock.

9.2.1 Electronic Submission via IPRO

Upload all the Required Bid Submission Items (See Section 4) and enter your cost in IPRO for each line item; as the “Total Cost” on the Bid Schedule OR $0.00 as your cost in IPRO. Upload all Required Bid Submission Items using Microsoft products such as Word and Excel. Do not submit items in .pdf format, unless provided otherwise in this ITB.

Be advised that that the Bidder for Bid evaluation and award purposes is the entity profile under which submit in IPRO, which must be the same legal entity presented in your uploaded response materials. If the entity identified on the state supplied Signature Page differs from the entity under which you submit your Bid in IPRO, the information provided on the Signature Page prevails.

9.3 Trade Secrets

If your Bid contains trade secret information which you have identified, you must also submit a redacted copy of the Bid (in electronic format, with the word “redacted” in the file name) with all trade secret information removed or blacked out; as well as a separate document containing a complete list (per the instructions in the three (3) paragraphs directly below) of all trade secret information which was removed or blacked out in the redacted copy.

Paragraph 28 of the Solicitation Instructions to Vendors describes trade secrets to “include a formula, pattern, compilation, program, computer program, device, method, technique or process that derives economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by other persons and is subject to the efforts that are reasonable under the circumstances to maintain its secrecy.” In addition to marking each page of the document with a trade secret notation (as applicable; and as provided in Paragraph 28 of the Solicitation Instructions to Vendors), Bidders must also:

Identify with particularity the precise text, illustration, or other information contained within each page marked “trade secret” (it is not sufficient to simply mark the entire page). The specific information you deem “trade secret” within each noted page must be highlighted, italicized, identified by asterisks, contained within a text border, or otherwise clearly delineated from other text/information and specifically identified as a “trade secret.”

Provide a separate document entitled “List of Redacted Trade Secret Information” which provides a succinct list of all trade secret information noted in your Bid; listed in the order it appears in your submittal documents, identified by Page #, Section #/Paragraph #, Title of Section/Paragraph, specific portions of text/illustrations; or in a manner otherwise sufficient to allow the State’s procurement personnel to determine the precise text/material subject to the notation. Additionally, this list must identify with each notation the specific basis for your position that the material be treated as exempt from disclosure.

AWARD

More than one (1) award may be issued for this ITB. Award will be made by either the lowest Extended Price by direct purchase or Buy-Back Price for direct purchase with buy-back, and may be by line item, groups of line items, or total of all line items, whichever the State determines to be in its best interest.

DIRECT PURCHASE

The monthly ownership cost will be determined by straight-line depreciation, with the monthly depreciation being the monthly ownership cost. ITD utilizes a twenty percent (20%) salvage value with a useful life of twelve (12) years.

Example:

Unit Price $100,000

DIRECT PURCHASE WITH BUY-BACK:

The monthly ownership cost will be determined as follows: Subtract the Buy-Back Price from the Unit Price and divide that amount by the respective number of months of ownership; then, add the loss of interest on the Unit Price to that monthly amount. The loss of interest on the Unit Price will be calculated by the difference in the Unit Price and the lowest Unit Price offered among all Bidders. This will be calculated at a five percent (5%) simple interest annually.

Example:

(24 months of ownership) November 1, 2019 (19 months of ownership)

$100,000 - $95,000 24 months $208.33 per month $105,000 - $102,500 19 months $131.58 per month

Loss of Interest

($100,000 - $100,000) x .05 12 months $0 per month ($105,000 - $100,000) x .05 12 months $20.83 per month

$208.33 per month $131.58 + $20.83 $152.41 per month

EVALUATING AWARD OPTIONS:

Based on the methods and examples above, the direct purchase with buy-back from Bidder B offers the State the lowest monthly ownership cost. This would be the bid determined to be in the best interest of the State.

Bidders may offer the direct purchase, the purchase with buy-back option, or both. Bidders do not have to bid on all line items to be considered for an award; however, for each line item you must Bid on all quantities requested for the direct purchase or direct purchase with buy-back.

Buy-back contract If the buy-back option is awarded, the Contractor must complete and submit Attachment 5 - Buy-Back Contract (including the surety payment bond) to DOP prior to the delivery of the Backhoes to ITD. The bonding surety must be registered and licensed with the Idaho Department of Insurance. The surety payment bond will not be accepted if surety is not registered and licensed in Idaho, and the Contract will not be executed by the State. If the Contractor fails to present an acceptable bond, this failure may be deemed just cause for the cancellation of the award of the Contract.

Delivery The Contractor must deliver and unload the Backhoes to the locations below between April 1, 2024 and May 1, 2024. You must indicate on Attachment 4 - Bid Schedule of the delivery date of the Backhoes.

15.2 Delivery must be made Monday through Friday, 8:00 am to 5:00 pm local time per location, excluding state of Idaho recognized holidays (https://www.idaho.gov/government/holidays.html) unless otherwise approved by ITD.

15.3 Delivery Locations:

0. ITD District 2 Yard, 2600 Frontage Road, Lewiston, ID 83501

0. ITD District 3 Yard, 8150 Chinden Boulevard, Boise, ID 83714

0. ITD District 4 Yard, 216 S Date St, Shoshone, ID 83352

0. ITD District 5 Yard, 5151 South 5th, Pocatello, ID 83204

0. ITD District 6 Yard, 206 N. Yellowstone, Rigby, ID 83442

The calculation will be based on the monthly ownership cost as outlined below, to determine which Bid is in the best interest of the state.

Warranty If the direct purchase is awarded: warranty must be for a minimum period of five (5) years, or five thousand (5,000) hours, whichever comes first, for the entire Backhoe, after acceptance.

If the buy-back is awarded: warranty must be for the entire period of the buy-back contract.

Warranty must include all parts, labor, travel, and freight, to replace a defective warranted item. Warranty excludes routine lubrication, fuel, oil, tires, antifreeze, lights, paint, fuses, glass, and other manufacturer’s auxiliary attachments.

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Records Maintenance Contractor shall maintain or supervise the maintenance of all records necessary to properly account for all payments made to the Contractor pursuant to the Contract. These records shall be retained by the Contractor for at least three (3) years after the Contract terminates, or until all audits initiated within the three (3) years have been completed, whichever is later.

Audit Rights The Contractor agrees to allow State and Federal auditors and State purchasing staff access to all the records relating to this Contract, for audit, inspection, and monitoring of services or performance. Such access will be during normal business hours or by appointment.

ITB Event 178 Backhoe Loaders

ATTACHMENT 1 - BIDDER QUESTIONS

PLEASE DO NOT IDENTIFY YOUR NAME OR YOUR COMPANY’S NAME OR PRODUCT NAMES OF INTELLECTUAL PROPERTY IN YOUR QUESTIONS.

ADD ROWS BY HITTING THE TAB KEY WHILE WITHIN THE TABLE AND WITHIN THE FINAL ROW.

The following instructions must be followed when submitting questions using the question format on the following page.

1. DO NOT CHANGE THE FORMAT OR FONT. Do not bold your questions or change the color of the font.

2. Enter the ITB section number that the question is for in the “ITB Section” field (column 2). If the question is a general question not related to a specific ITB section, enter “General” in column 2. If the question is in regards to a State Term or Condition or a Special Term or Condition, state the clause number in column 2. If the question is in regard to an attachment, enter the attachment identifier (example “Attachment A”) in the “ITB Section” (column 2), and the attachment page number in the “ITB page” field (column 3).

3. Do not enter text in the “Response” field (column 5). This is for the State’s use only.

4. Once completed, this form is to be e-mailed per the instructions in the ITB. The e-mail subject line is to state the ITB number followed by “Questions.”

ITB 178 Backhoe Loaders Page 12

ITB Event 178 Backhoe Loaders

Attachment 2 – Specifcations

The brand names specified in this solicitation are intended to be descriptive, but not restrictive; indicative of the quality and characteristics of items that meet the minimum requirements. Bidders offering an “equal” must include documentation which demonstrates, to the ITD’s satisfaction, that the offered item(s) meets the requirement of the solicitation. In the event documentation is not satisfactory, ITD reserves the right to seek clarification from the Bidder. Failure to provide satisfactory documentation or a clarifying response may eliminate the Bidder from further consideration.

1. Description

0. Type – Fourteen (14) ft four (4) in, four (4) - wheel drive, and integral frame design;

0. Weight – Eighteen – thousand (18,000) lb;

0. Wheelbase – Eighty – two (82) in;

1. Engine

1. Type – Four (4)-cycle, turbocharged diesel. Engine must meet US environmental protection agency (EPA) tier four (4) final emission requirements;

1. Piston Displacement – Two hundred twenty (220) cu in;

1. Power Rating – Ninety-two (92) horsepower (HP) net;

1. Torque Rating – Two hundred fifty (250) ft lb;

1. Air Cleaner – Manufacturers heaviest duty dry type with restriction indicator;

1. Cold Weather Starting Aid – Thermostat controlled glow plugs or manifold preheater;

1. Antifreeze – Ethylene glycol base to Minus – thirty Fahrenheit (-30° F);

1. Block Heater – Electric with stationary, weatherproof receptacle

1. Oil Sample Fitting – Titan Laboratories model no. OD1014. Or equal

1. Transmission

2. Type – Constant mesh with power reversing (on the go) in at least three (3) gears forward and reverse with torque converter;

2. Gear Selection – Four (4) speeds forward and three (3) speeds reverse and;

2. Speed – Two (2) to twenty (20) miles per hour (MPH) (approximate).

1. Final Drive

3. Type – Inboard or outboard planetary or torque proportioning bull gear and;

3. Differential Lock/No Spin – Automatic or foot operated.

1. Brakes

4. Type – Wet Disc;

4. Control – Foot operated, both individually and simultaneously;

4. Parking brake with indicator;

1. Axles

5. Front – Twenty-six thousand (26,000) lb static load rating (Society of Automotive Engineers (SAE) SAE.org J43.

5. Rear – Twenty – eight thousand (28,000) lb static load rating (SAE J43).

1. Tires

6. Type – Industrial tread;

6. Front – Eight (8) - ply rating and;

6. Rear – Ten (10) - ply rating.

8. Hydraulics

8.1 Capacity – Forty – nine (49) gallons per minute (GPM);

8.2 Tank – Capacity enough to keep oil temperature below One – hundred sixty Fahrenheit (160° F);

8.3 Cylinders – Cylinder shafts chromed;

8.4 Cooler – Capable of cooling hydraulic motor-driven attachments.

9. Electrical

9.1 Type – Twelve (12) -volt with alternator rated for air conditioning;

9.2 Lights – Headlights, tail, directional, and front and rear work lights.

10. Fluid Filters (Buy-Back Only)

10.1 If the buy-back is awarded: All fluid filters must be supplied to the delivery location for each backhoe for duration of buy-back contract. All filters must be provided, at the time of delivery, per manufacturer’s scheduled service intervals detailed in operator’s manual. ITD will average four - hundred fifty (450) hours, on each Backhoe, in an eighteen (18) month period.

11. Accessories

11.1 Front Counterweight – Two hundred (200) lb or recommended by the manufacturer for Backhoes operating on a Thirty Degree (30°) incline; calcium chloride is not acceptable in lieu of steel counterweights;

11.2 Backup Alarm – Three hundred (300) series Preco-Matic self-adjusting type;

11.3 Cab – Fully enclosed, equipped with factory installed amplitude modulation/frequency modulation (AM/FM) stereo cassette radio, pressurized heater, defroster, air conditioning, roll over protection system (ROPS) protection requirements and sound suppression to meet the occupational safety and health administration (OSHA) requirement;

11.4 Floor mat;

11.5 Security Lock Kit – For fuel, oil, and cab;

11.6 Windshield Wipers – For both front and rear windows with washers;

11.7 Warning Light – Two (2) fifteen (15) in light emitting diode (LED), roof-mounted. Center of operator’s cab, one (1) on the street side, one (1) on the curb side. Controlled by interior cab mounted switch;

11.8 Slow moving vehicle sign mounted at rear of backhoe;

11.9 Mirrors – Interior and dual exterior rearview mirrors;

11.10 Seat – Deluxe suspension type with armrests and three (3) in wide seat belt;

11.11 Ride Control System – Operator controlled nitrogen oil accumulator installed in line with the loader lift cylinders to control fore and aft pitching during transport.

12. Loader

12.1 Size – One point twenty-five (1.25) cubic yard (CY), standard bucket. Nominal heaped with bolt-on cutting edge;

12.2 Lifting Capacity – Seven thousand two hundred (7,200) lb full height;

12.3 Breakout Force – Eleven thousand (11,000) lb;

12.4 Dumping Height– Nine (9) ft one (1) in at forty – four-degree (44°) dump angle;

12.5 Bucket – Width must equal or exceed rear tire outside width;

12.6 Bucket Self-Leveling/Return to Dig – Automatic with level indicator;

12.7 Reach – Thirty – two (32) in at full height at forty – four-degree (44°) dump angle;

12.8 Control Handle – Single lever;

12.9 Cutting Edge – Installed by the Contractor at time of delivery.

Note: If the buy-back is awarded, ITD will return the Backhoes with the cutting edges. ITD will not be responsible for any wear of the cutting edges or bucket teeth.

13. Backhoe

13.1 Digging Depth – Seventeen (17) ft six (6) in with two (2) ft flat bottom with extendable dipper stick;

13.2 Overall Reach – Twenty – one (21) ft nine (9) in from swing pivot;

13.3 Bucket – Twenty – four (24) in heavy-duty trenching bucket;

13.4 Swing Arc – One hundred eighty degrees (180°);

13.5 Bucket Rotation – Two hundred four degrees (204°);

13.6 Breakout Force – Fourteen thousand (14,000) lb bucket cylinder and 7,000 lb. dipper stick cylinder;

13.7 Thumb – Hydraulic type for backhoe and bucket.;

13.8 Control Valves – Hand-operated for boom, dipper, bucket, and swing;

13.9 Control Handles – Two (2), joystick type and;

14.10 Stabilizers – Equipped with rubber street pads.

ATTACHMENT 3 - PRODUCT INFORMATION

Bidder Name:

Provide your product information in the fields below:

Make and Model:

Diesel Engine # Cylinders

Diesel Engine Displacement (cu. in.)

Diesel Engine Rated HP at RPM

Torque Converter Size (in.)

Torque Converter Type

Transmission Type

Transmission # Forward Speeds

Transmission # Reverse Speeds

Front Tire Size and Ply

Rear Tire Size and Ply

Rear Outside Tire Width (in.)

Loader Bucket Size (cu. yd.)

Loader Bucket Width (in.)

Lifting Capacity (lb.)

Breakout Force (lb.)

Dump Height at 45° Angle (in.)

Bucket Roll Back (in.)

Digging Depth with 2 ft. Flat Bottom (ft.)

Maximum Reach from Swing Pivot (ft.)

Digging Force, Bucket Cylinder (lb.)

Digging Force, Dipper stick Cylinder (lb.)

Arc Swing

Bucket Curl (loading position)

Recommended Counter Balance, Front (lb.)

Recommended Counter Balance, Rear (lb.)

Do you meet the specifications provided in Attachment 2 - Specifications?

YES *NO

*If your product offered does not meet or if it exceeds any of the specifications, Bidder must provide an explanation of how the product offered is functionally equivalent to the stated specification as well as descriptive literature that supports the product offered.

Attachment 4 - BID SCHEDULE

ITB 178

BACKHOE LOADERS

Company Name of Bidder:

Contact Name/Phone:

Contact E-mail:

VENDOR INSTRUCTIONS

1. Vendors are "NOT" not required to populate Unit Price on all line items in each group in order to be considered for award.

2. Vendors must verify Extended Price and Total Cost. (Extended Price and Total Cost will Auto-Populate).

3. Submitting vendor must be an authorized distributor of the Backhoe loaders being offered.

4. Bidders may offer the Direct Purchase, the Direct Purchase with Buy-Back, or both; however, for each line item Bid, you must Bid on all quantities requested for the Direct Purchase or Direct Purchase with Buy-Back.

5. Your fully burdened Extended Price and Total Cost must include all cost associated with meeting the specifications outlined in this solicitation.

This completed Bid Schedule must be submitted with your response.

Direct Purchase - Provide your fully burdened Unit and Extended Price, to include all costs associated with meeting the specifications in this ITB:

Direct Purchase with Buy-Back - Provide your fully burdened Unit Price, Buy-Back Price Buy Back Date, to include all costs associated with meeting the specifications in this ITB:

No Backhoe will be returned before November 1, 2025 or after five (5) years from the original delivery date.

Delivery within days ARO

THIS ATTACHMENT MUST BE COMPLETED AND RETURNED WITH YOUR BID RESPONSE

ATTACHMENT 5 - BUY-BACK CONTRACT AND SURETY

ITB 178

BACKHOE LOADER BUYBACKS

The purpose of the following Buy-Back and Surety Payment Bond contract is to establish the obligations for the Idaho Transportation Department and the Contractor listed below.

The Contractor will guarantee to purchase from the Idaho Transportation Department the Backhoe Loaders listed below for the sum of ________________________________________________ ($____________________) lawful money of the United States. Both the Buy-Back and Surety Payment Bond contracts are to be completed and returned to Division of Purchasing prior to delivery of Backhoe Loaders.

This payment is due on or before _______________________________. Failure to make this payment by the Contractor will result in the Idaho Transportation Department collecting the monies due from the Surety Payment bond affixed to this contract.

In consideration for this payment, the Idaho Transportation Department will provide the following:

In case of change of corporate structure or loss of identity by assimilation or merger with other companies, this agreement shall remain in effect and be binding on the successor Company (ies).

The Idaho Transportation Department reserves the right to sell, trade, retain, or otherwise dispose of the Backhoe Loaders purchased under this agreement, at its discretion at any time. The Idaho Transportation Department will notify the Contractor if any of these options are exercised, in writing, within ten (10) calendar days of choosing an option. Backhoe Loaders to be purchased:

MAKE

MODEL

VEHICLE IDENTIFICATION NUMBER

DESCRIPTION

Signed:

Contractor

ITD Purchasing Agent or Designee

Signature

Date

Signature

Date

Print Name

Printed Name

Title

ITD Maintenance Services Manager or Designee

Corporate Name and Address

Signature

Date

Printed Name

SURETY PAYMENT BOND

ITB 178

BACKHOE LOADERS

KNOW ALL MEN BY THESE PRESENTS, That we ____________________________________, a corporation of ___________________________________________________________________________ as Principal, and _____________________________________________________________________________ as Surety, are held and firmly bound unto the state of Idaho in the penal sum of ___________________________ ____________________________________________________________ ($__________________) lawful money of the United States, which sum is agreed to be the maximum liability hereunder, well and truly to be paid, and for the payment of which we and each one of us bind ourselves, our heirs, executors, administrators and assigns, jointly and severally, firmly by these presents.

The condition of this instrument is such, that whereas the Principal has entered into a certain agreement, hereto attached, with the state of Idaho, dated _______________________________, 20____, for the purchase of the Backhoe Loaders listed in the Division of Purchasing Bid ITBXXX.

NOW, THEREFORE, if the Principal pays to the Idaho Transportation Department ten percent (10%) of the repurchase price listed in the Division of Purchasing Bid ITB2023XXXX on or before _____________, 20____, then this obligation shall be void, otherwise it will remain in full force and effect. IN WITNESS WHEREOF, the Principal and Surety have executed this instrument to be effective on the date of the purchase agreement as set forth above.

CONTRACTOR (Individual or Partnership):

(SEAL)

(Principal)

(Principal)

(Business Address)

CONTRACTOR (Corporation):

Attest:

(Principal)

(AFFIX CORPORATE SEAL)

BY _______________________________

(Signature)

(Print Name)

(City)

(Address)

(Title)

CORPORATE SURETY:

Attest:

(Surety)

(AFFIX CORPORATE SEAL)

BY _______________________________

(City)

(Address)

(Title)

RESIDENT AGENT:

BY _______________________________

DATE __________________________

PLEASE ATTACH POWER OF ATTORNEY

(Name of Firm)

_____________________,ID_______

(Business Address & Zip Code)

EXHIBIT 1 CONTRACT DESCREPANCY

Discrepancy Information: This Contract Discrepancy Notice identifies the Discrepancy(ies) found by ITD while monitoring the Contractor’s performance required per the referenced contract. Items identified as “Discrepancy” require a response from the Contractor. Items identified as “Observation” are areas of concern that may lead to a future Discrepancy if not addressed. Observations do not require a response unless otherwise noted in this notice.

ITD has identified the following Discrepancy(ies):

(Add additional tables for multiple discrepancies)

ITD Contract Monitor - Check appropriate box with regard to Contractor’s resolution

Reason for Rejection or Partially Accepted

Anticipated Follow Up Date on Resolution

ITD Contract Monitor Signature

Date

Contractor - Sign below to indicate your understanding of the Discrepancy(ies) and your responsibility for resolution.

Contractor Printed Name

Title

Contractor Signature

Date

Resolution

ITD Contract Monitor – Sign below to indicate that each Discrepancy has been resolved based on the actions detailed in the Contractor’s Resolution for each Discrepancy.

ITD Contract Monitor Signature

Date

ITD has identified the following Observations (no response required):

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