CONTRACT PRICE FORM

(Page-1) This form is to be completed in its entirety, is not to be altered in any way and is to contain only the price or prices stipulated on the form.

Contract # WO427F28SB Quantities are for bid evaluation only, and are not meant to establish minimum, maximum or exact quantities.

MD 611 (Stephen Decatur Highway) from the intersection of US 50 (mile point 8.51) to just north of entrance to National Seashore Lane, (mile point 1.32) leading into Assateague Island Parks. Approx 17 acres

MD 376 (Assateague Rd) from intersection of US 113 (mile point 00.42) to MD 611 (mile point 4.56) Approx 9 Acres.

MD 374 (Libertytown Rd.) from intersection Prospect Dr (mile point 8.08) to Worcester/Wicomico County Line at the Pocomoke River (mile point 0.00) Approx 19 acres

MD 354 (Whiton Rd) from Worcester/Wicomico County Line (Whiton Crossing Rd - mile point 7.64) to MD 12 (Snow Hill Rd – mile point 0.00) Approx 9 acres

MD 12 (Snow Hill Rd) from Pocomoke River Bridge (Out Corp Limits of Snow Hill – mile point 13.00) to Worcester/Wicomico County Line (mile point 23.37) Approx 27 acres

MD 12 (Snow Hill Rd) from US 113 (mile point 11.04) to Virginia State Line (mile point 0.00) Approx 27 acres

For the Contractor:

Company Name & Address

City State Zip

Phone _____________________ Fax ______________________Email _____________________________________

Representing the above Company _______________________________

SIGNATURE

Print Name & Title

SOCIAL SECURITY NO. OR

FEDERAL TAX ID NO. _________________________ DATE: ___________________

Maryland Department of Transportation

SMALL BUSINESS CONTRACT AFFIDAVIT

********** PROVIDING FALSE INFORMATION **********

Anyone providing false information to the State of Maryland in connection with obtaining or attempting to obtain a contract under Small Business Reserve or Preference procurement may be subject to the following:

1. A determination by a Procurement Officer that a bidder/offeror is not responsible;

2. A determination that a contract entered into is void or voidable under § 11-204 of the State Finance and Procurement Article of the Annotated Code of Maryland;

3. Suspension and debarment under Title 16 of the State Finance and Procurement Article;

4. Criminal prosecution for procurement fraud (§ 11-205.1 of the State Finance and Procurement Article), perjury, or other crimes; and

5. Other actions permitted by law.

********** FAILURE TO MEET MINIMUM QUALIFICATIONS **********

Any Bidder or potential bidder failing to meet the qualifications of a "small business" specified in § 14-501(c) of the State Finance and Procurement Article will be ineligible to participate in a procurement designated for a Small Business Reserve under § 14-504 or Small Business Preference under § 14-206 - 207. Any person or company bidding on Small Business Reserve or Preference procurement and not qualifying as a small business under § 14-501(c) will have its bid or offer rejected on the ground that the bidder is not responsible.

I AFFIRM THAT:

I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.

SMALL BUSINESS QUALIFICATION NUMBER

Date of Most Recent Qualification__________________________________

DATE:_____________

BY:_____________________________________________________________

Signature (Authorized Representative and Affidavit)