9.f Northwest AsphaltCITY OF SCANDIA
PROPOSAL FORM (�
Mark Envelope: I, 5 keJ � `'k -c 1,�/l
To the Public Works Director:
The Subscriber hereby proposes to furnish the following hereinafter named, in
accordance with the provisions of the proposal ding document of which this forms a
part:
ITEM
PROPOSAL PRICE
TOTAL
t -71,300. v�
Proposal Price in words: J� �� ✓t.`�-/� �r k4-
1- t rrJ
Number of Calendar Days to Complete Project from Notice to Proceed.—[JD
It is understood the right is reserved by the City of Scandia to increase, decrease, or
delete any of the above quantities. The City of Scandia reserves the right to award
all or any parts of this proposal to one or more proposers as determined by the lowest
responsible proposal and/or specifications, at its sole discretion.
Executed
201 3 .
Quote submitted by:
this day of
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Title �Ru
Company I \IQI- t'klA= 4- th)0 krn-Y, Sly C
Street Address co c,,L \ 1�CJ cd
City, State, Zip n Imo, KoWaae .0 vyW 55-5-79
Phone n(5 2—
Federal
Federal I.D. No. q l -
INFORMATION SHEET
The Points of Difference where the proposal does not comply with the specifications
are listed as follows:
INFORMATION SHOWING QUALIFICATIONS
OF PROPOSER
The undersigned states that the names and addresses of persons interested as
principles in this proposal are as follows: (Write first name in full). If a partnership or
corporation, give the names and address of all partners or officers:
The proposers also states on the line below, if a corporation, the name of state in
which incorporated and the date of said incorporation.
VA',v1v1e--5 o +-e— 3 ' ),q r -16
The undersigned states that they are citizen(s) of the United States and that all the
partners, officers, or principals interested herein are citizens of the United States,
except (give full name and addresses):
The undersigned offers the following information relative to the facilities, ability and
financial resources available for the fulfillment of the Contract is such be awarded to
him.
FACILITIES: That he or they own and have available for immediate use on the
proposed work the following plant and equipment:
ABILITY: That he or they have performed the following work (give location, kind, size
or cost, and reference to name and address of client and engineer):
FINANCIAL RESOURCES: That information relative to his or their financial
resources can and may be obtained from the following (give name, business and
address): W �l S �Io
LISTING OF SUB -CONTRACTORS
The undersigned offers the following information relative to the sub-
contractors he intends to use on this contract if such be awarded to him.
1. Description of Work to be Sublet:
Name and Address of Subcontractor:
2. Description of Work to be Sublet:
Name and Address of Subcontractor:
3. Description of Work to be Sublet:
Name and Address of Subcontractor:
4. Description of Work to be Sublet:
Name and Address of Subcontractor:
Signature of Proposer: Proposer: I jo/-4�5 t ,IAS Cko-ti,
By:
Title: ,p, b4q ,