Quote Submission Form_Hot Mix Asphalt.pdf

QUOTE SUBMISSION FORM

Production of PCC Pavement Model for ERDC GSL

Engineer Research and Development Center

ATTN: Angie Stokes

3909 Halls Ferry Rd.

Vicksburg, Mississippi 39180-6199

EMAIL: Angela.M.Stokes@usace.army.mil

601-634-4878

Item

No.

Description Price

Hot Mix Asphalt Mixture, to include the following (Reference the Performance Work

Statement for further detail):

Aggregates

Fine Aggregate

Mineral Filler

Asphalt Binder

Mix Design

Construction

TOTAL COST

1. REGISTERED IN THE SYSTEM FOR AWARD MANAGEMENT (SAM)?

YES _________ NO __________

NOTE: If you are not registered with SAM (formerly CCR), an award cannot be made to your institution. You may register electronically at https://www.sam.gov/portal/public/SAM/.

Registering electronically will expedite the registration process but may not ensure registration prior to the award of the contract.

2. PLEASE PROVIDE THE FOLLOWING INFORMATION:

Contractor/Vendor Name: ______________________________________________________

Contractor DUNS #: ___________________________________________________________ mailto:Angela.M.Stokes@usace.army.mil http://www.sam.gov/portal/public/SAM/ http://www.sam.gov/portal/public/SAM/

Contractor Cage Code: _________________________________________________________

Contractor Tax ID: ____________________________________________________________

Contractor Point of Contact: _____________________________________________________

Point of Contact Phone Number: _________________________________________________

Point of Contact E-mail Address: _________________________________________________

This quote is valid through the following date: ______________________________________