S-10000-00004195 Att D - Application Form.pdf
PDF 127 KB Posted
- Attached to
- RFA for Bulk Potable Water Delivery Service
- Solicitation number
- S-10000-00004195
- Issued by
- Jackson County, Oregon
About this file
This document is an Application Form for RFA # S-10000-00004195 - Bulk Potable Water Delivery Service, issued by an unnamed Agency. The application allows Applicants to indicate the counties in Oregon for which they are applying to provide Bulk Potable Water Delivery Service. Applicants must provide their hourly rate, which must be all-inclusive to cover fuel, vehicle maintenance, and equipment sanitation costs.
The related state and local contract opportunity is for Bulk Potable Water Delivery Service, focused on Klamath County, Oregon. The application form does not specify response due dates, award dates, contract terms, or renewal options.
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Text version
RFA # S-10000-00004195 – Bulk Potable Water Delivery Service (Agency Internal #5470)
ATTACHMENT D – APPLICATION FORM
If Applicant is awarded a Contract, Agency will use the following information to create the awarded Contract or to conduct Contract Negotiations with the Applicant.
CONTACT FOR CONTRACT NEGOTIATIONS
D1
Name
Title
Address
Phone
Email address
BULK POTABLE WATER DELIVERY SERVICE LOCATION DESIGNATION
Applicant shall check the boxes to indicate the county or counties for which the Applicant is applying to provide Bulk Potable Water Delivery Service.
D2
Baker Benton Clackamas Clatsop Columbia Coos Crook Curry Deschutes Douglas Gilliam Grant Harney Hood River Jackson Jefferson Josephine Klamath Lake Lane Lincoln Linn Malheur Marion Morrow Multnomah Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington Wheeler Yamhill All Counties
HOURLY RATE
D3
Applicant’s hourly rate to provide Bulk Potable Water Delivery Service must be an all-inclusive hourly rate, to include, but not limited to, the following: Fuel Costs, Vehicle Maintenance Costs, and Equipment Sanitation Costs.
Hourly Rate: $________________ per hour
Signature: Date: .
(Authorized Applicant Signature)
Printed Name:_________________________________ Title:_________________________
File details come from the government source that posted it. Updated .