Response Sheets~8.docx

Response Sheet #1

TO BE RECEIVED NO LATER THAN 9/3/2014 at 2:00 PM

If not interested, please return “No Response”

Administrative Services – Concord Office Procurement Team Leader P.O. Box 9125 Concord, MA 01742-9125

Date:

I am qualified to submit the following response to this RFR. I am interested in serving DOC Regions checked below. In addition I have read and understand all amendments, addenda and written answers to this procurement.

Please check all applicable regions: Do not leave this section blank !

Region 1

Region 4

(Region details are listed in RFR)

Region 2

Region 5

Region 3

Region 6

Company Name

Street Address Web Site Address

City

State

Zip Code

Telephone Number

Fax Number

Federal ID Number

E-mail Address

Account Manager

Phone Number of Account Manager

( PRINT or TYPE ) Name and Title of authorized person filling out this contract package

Signature Date

______________________________________________ and/or ____________________________ Company name of MWBE Subcontractor Company name of ancillary provider

Response Sheet #2

DRINKING WATER QUALITY ANALYSIS

PLEASE ENTER CHECKMARK FOR EACH TEST YOU PROVIDE

TEST CHECKMARK

TRIHALOMETHANES

VOLATILE ORGANIC CHEMICALS

INORGANIC CHEMICALS

HALOACETIC ACIDS

SYNTHETIC ORGANIC COMPOUNDS

RADIONUCLIDES

YOUR CATALOGUE / PRICELIST MUST ACCOMPANY THIS RESPONSE PAGE.

Is there a charge for sterile containers and/or labels? _______________________________________

Do you pick-up and deliver? ____________________________ What is the cost for this? _______________

Enter other related tests not mentioned above.

The Department of Correction will not process any payment for any hidden costs. The department is not responsible for and will not pay for any changes that are not accepted as part of this contract. You may attach a list of additional costs if there is not enough room here.

Description of ADDITIONAL Service Charges or Fees:

Response Sheet #3

TESTING REAGENTS AND RELATED EQUIPMENT

Do you provide a 24/7 Help Line? Enter it here: ____________________

Will you provide the testing machine at no cost for the duration of the contract? ________

How often do you recalibrate the testing machine to maintain accuracy? ________________

List below the tests that you perform. How many tests are included in each package?____

TEST Cost/Pkg

TEST Cost/Pkg

How do you charge for other TESTING MATERIALS and RELATED EQUIPMENT not listed above?

Price List of TESTING MATERIALS & EQUIPMENT at _______________%-Off List Price (Attach Price List)

Catalogue of TESTING MATERIALS & EQUIPMENT at _______________%-Off Catalogue (Attach Catalogue)

TESTING MATERIALS and EQUIPMENT at COST PLUS _______________Percent

Warranty on SERVICE:____________________________

Do you REPAIR or REPLACE related equipment? _____________________

EARLY PAYMENT DISCOUNT OF __________% ___________Days.

(Print Your Name) Your Signature

LIST ANY OTHER APPLICABLE CHARGES:

The Department of Correction will not process any payment for any hidden costs. The department is not responsible for and will not pay for any charges that are not accepted as part of this contract.

Response Sheet #4 Maintenance, Service and Parts – Time & Materials

Please “X” all Regions that apply to this response (A list of regions can be found on pg. 11)

Region 1

Region 4

Region 2

Region 5

Region 3

Region 6

Do you provide a 24/7 Help Line? Enter it here: _______________________

What is your response time from “initial call” to site arrival? ________________________

Please checkmark area(s) that you are certified to provide.

For CL-17 Chlorine Analyzer / pH Adjustment

For Foxboro Company Controller

For Parco System Controls for pump stations

For Aurora Pumps

LABOR $ per hour per tech Normal Business Hours

RATES:

$ per hour per tech Non-Business Hours

$ per hour per tech Holidays

$ per hour per tech Weekends

How do you charge for MATERIALS and SUPPLIES?

Price List of TESTING MATERIALS & SUPPLIES at _______________%-Off List Price (Attach Price List)

Catalogue of TESTING MATERIALS & SUPPLIES at _______________%-Off Catalogue (Attach Catalogue)

MATERIALS and SUPPLIES at COST PLUS _______________Percent

Warranty on SERVICE:____________________________

Warranty for MATERIALS & SUOOLIES: _________________________________

EALRY PAYMENT DISCOUNT OF __________% ___________Days.

The Department of Correction will not process any payment for any hidden costs. The department is not responsible for and will not pay for any charges that are not accepted as part of this contract.

Response Sheet #5 Water Well Supply Line Repairs

Please “X” all Regions that apply to this response (A list of regions can be found on pg. 11)

Region 1

Region 4

Region 2

Region 5

Region 3

Region 6

Please checkmark area(s) that you are certified to provide.

Water main repairs

Live water main tapping

Water main pipe cutting

Ground water well development, including pumps and motors

Supply configured thermoplastic tanks for chemical storage

Replace line stops

Pressure testing

Chlorination

Do you provide a 24/7 Help Line? Enter it here: _______________________

What is your response time from “initial call” to site arrival? ________________________

LABOR $ per hour per tech Normal Business Hours

RATES:

$ per hour per tech Non-Business Hours

$ per hour per tech Holidays

$ per hour per tech Weekends

How do you charge for MATERIALS and SUPPLIES?

Price List of TESTING MATERIALS & SUPPLIES at _______________%-Off List Price (Attach Price List)

Catalogue of TESTING MATERIALS & SUPPLIES at _______________%-Off Catalogue (Attach Catalogue)

MATERIALS and SUPPLIES at COST PLUS _______________Percent

Warranty on SERVICE:____________________________

Warranty for MATERIALS & SUOOLIES: _________________________________

EALRY PAYMENT DISCOUNT OF __________% ___________Days.

The Department of Correction will not process any payment for any hidden costs. The department is not responsible for and will not pay for any charges that are not accepted as part of this contract.

Bidder’s Response Checklist

Bidder Name___________________________

Contractor Authorized Signature Verification

Standard Contract Form

Commonwealth Terms and Conditions

W-9 Form

Authorization for Electronic Payment Form

Supplier Diversity Plan (SDP) Form

Environmentally Preferable Products Form

Prompt Payment Discount Form

Business Reference Form

Catalogue / Price List

Response Sheets (within RFR document)

Certificates of Insurance

Business Cards (Two of each)

Please telephone (508)422-3390, if you require assistance, or have questions about, or have difficulty downloading these forms from www.commbuys.com.

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