wv43Oxygen.pdf

WV-43 (REV. 06/12 /12)

Vendor w

Address w

Telephone Number w ( )

Date Acct. No.

Return by ______________ on ______________

Item Number Quantity Unit Price AmountDescription

Delivery Requirements F.O.B.

REQUEST FOR QUOTATIONS

THIS IS NOT AN ORDER

Req. No.

Delivery DateTermsFEIN

TOTAL $

Vendor - Authorized Representative Signature of Authorized Representative

Bid To Be Delivered To:

Goods/Services To Be Shipped To:

GENERAL TERMS AND CONDITIONS: The Agency Master Terms and Conditions located on the Purchasing Division's website at http:/// www.state.wv.us/admin/purchase/TCA.pdf, ("Terms and Conditions") are hereby made a part of this agreement and are specifically incorporated herein by reference. By signing this document, Vendor certifies it has reviewed the Terms and Conditions, fully understands them, and agrees to be bound by their provisions.

By signing below, I certify that I have reviewed this Requisition for Quotations in its entirety; understand the requirements, terms and conditions, and other information contained herein; that I am submitting this quotation for review and consideration; that I am authorized by the bidder to execute this bid or any documents related thereto on bidder's behalf; that I am authorized to bind the bidder in a contractual relationship; and that to the best of my knowledge, the bidder has properly registered with any State agency that may require registration.

11522 Ohio River Road West Columbia, WV 25287

(304) 675-0860

(304) 675-0866 fax ATTN: Carol Staats GoodsServices To Be Shipped To: Lakin State Hospital 11522 Ohio River Rd.

West Columbia, WV 25287

The State of West Virginia, Department of Health and Human Resources, Behavioral Health and Health Facilities, Lakin Hospital is accepting bids to establish a contract for medical oxygen and tanks.

Questions regarding this Request for Quotation must be submitted in writing no later than 1:00 PM on February 1, 2017. Questions will be accepted via hand delivered hardcopy, via fax, USPS, or courier to Lakin Hospital, 11522 Ohio River Road, West Columbia, WV 25287 Attention: Carol Staats Bids must be submitted on or before February 10, 2017 at 1:00 PM. Bids will be accepted via hand delivered hand copy, via fax, via USPS or courier. No email bids will be accepted. However, we encourage submission via WVOASIS. If you have any issues with bid submission through WVOASIS, please call the HELP desk at (304) 558-6708. They will be happy to assist you.