CONSOLIDATED SCHOOL DISTRICT 158 October 12, 2014 Specifications for Fork Truck Bid #

Similar documents
CONSOLIDATED SCHOOL DISTRICT 158 SPECIFICATIONS FOR ICE MELT COMPOUND BID #

ADVERTISEMENT FOR BIDS CSD NO. 158 BID # B CONSOLIDATED SCHOOL DISTRICT # ELEMENTARY SCHOOLS CARPET INSTALLATION

County of Gillespie. Bid Package for FUEL - BOBTAIL DELIVERY. Bid No November 2018

County of Gillespie. Bid Package for COLD MIX LAY ASPHALT. Bid No November 2018

GLENBARD TOWNSHIP HIGH SCHOOL DISTRICT # Crescent Boulevard, Glen Ellyn, IL , (630) , INVITATION TO BID

County of Gillespie. Bid Package for GRAVEL. Bid No November 2018

PURCHASING DEPARTMENT

2018 Recreation Center Dectron Unit - R22 Refrigerant

BID NO Troy School District

County of Gillespie. Bid Package for CONCRETE. Bid No November 2018

THE PROVISION OF CRACK SEAL MATERIAL 2017/2018 NOTICE TO BIDDERS. This entire Bid Package, which includes the following:

St. George CCSD #258

INVITATION TO BID BID NO WEIGHT ROOM EQUIPMENT FOR TROY SCHOOL DISTRICT

INSTRUCTIONS TO VENDORS

Core Technology Services Division PO Box Grand Forks, ND

City of Portsmouth Portsmouth, New Hampshire Department of Public Works. Bid# Toyota 8FDU 25 Diesel Forklift INVITATION TO BID

REQUEST FOR PROPOSAL BEVERAGE SERVICE FOR ILLINOIS VALLEY COMMUNITY COLLEGE PROPOSAL #RFP2016-P04

Request for Proposal (RFP) For Commercial Property Real Estate Broker/Agent Company:

INVITATION FOR BID. Furnish: Installation of One (1) Security Cage for a Rooftop Heating and Air Conditioning Unit. Company Name:

PURCHASING DEPARTMENT

MUNDELEIN ELEMENTARY SCHOOL DISTRICT 75 BID PACKAGE FOR CHILLER REPLACEMENT AT LINCOLN SCHOOL

PURCHASING DEPARTMENT

Vertical Milling Machine

INVITATION FOR BID. Furnish: Provide Labor, Materials and Equipment for Removal and Installation of a New Gas Boiler

PURCHASING DEPARTMENT

BROKEN ARROW PUBLIC SCHOOLS 701 SOUTH MAIN BROKEN ARROW, OK PHONE (918) FAX (918)

Invitation To Bid. for

REQUEST FOR PROPOSALS (RFP) FOR GATEWAY ENTRANCE SIGNAGE DESIGN, FABRICATION AND INSTALLATION FOR THE VILLAGE OF SPARTA

BID PROPOSAL NO. 969 DESCRIPTION: ADRESSABLE AMPLIFIED SPEAKERS

BROWNSVILLE NAVIGATION DISTRICT OF CAMERON COUNTY, TEXAS PORT OF BROWNSVILLE. Specifications for Bid. Crushed Limestone

Finance & Technology Administrator (815) ext 223

NORTHAMPTON AREA SCHOOL DISTRICT REQUEST FOR BIDS

Snow Removal Services Request for Proposals December 1, April 30, 2019

REQUEST FOR BIDS. MCC HVAC Replacement Units

INSTRUCTIONS TO BIDDERS

HOPKINSVILLE WATER ENVIRONMENT AUTHORITY

VILLAGE OF BENSENVILLE

Champaign Park District: Request for Bids for Playground Surfacing Mulch

Invitation to Bid (ITB) for Athletic Trainers Services

COUNTY OF OSWEGO PURCHASING DEPARTMENT

CHAMPAIGN COMMUNITY SCHOOL DISTRICT #4 Champaign, Illinois

CHEROKEE NATION BUSINESSES, L.L.C. REQUEST FOR PROPOSAL ( RFP ) PROJECT NAME: CNE Ad Agency RFP NUMBER: DATED: TABLE OF CONTENTS

GLENVIEW PARK DISTRICT 1930 PRAIRIE STREET GLENVIEW, ILLINOIS (847)

INVITATION TO BID Retaining Wall

ALL TERRAIN SLOPE MOWER

CONSOLIDATED SCHOOL DISTRICT 158 ALGONQUIN, ILLINOIS SNOW REMOVAL BID SPECIFICATION Bid # May 11, 2015

Request For Proposal (RFP) for

CHEROKEE NATION ENTERTAINMENT, L.L.C. REQUEST FOR PROPOSAL ( RFP ) PROJECT NAME: Professional Parking Valet Services RFP NUMBER: DATED:

INVITATION FOR BID ATTENTION: This is not an order. Read all instructions, terms and conditions carefully.

BID NO be obtained. must be Rankin. no later. subsequently. addressed or. part; to. make awards. District, Troy, MI 48083

INDEPENDENT SCHOOL DISTRICT NO. 273 District Media and Technology Services 5701 Normandale Road, Suite 339 Edina, MN 55424

Bulloch County Board of Commissioners 115 N Main Street Statesboro, GA NOTICE OF SOLICITATION INVITATION TO BID

COUNTY OF COLE JEFFERSON CITY, MISSOURI

Request for Quotation

Request for Quotation

REQUEST FOR SEALED BID PROPOSAL

PURCHASING DEPARTMENT

CHEROKEE NATION ENTERTAINMENT, L.L.C. REQUEST FOR PROPOSAL ( RFP )

GUILFORD COUNTY SCHOOLS Invitation for Bids

REQUEST FOR SEALED BID PROPOSAL

EL PASO COUNTY COMMUNITY COLLEGE DISTRICT POST OFFICE BOX EL PASO, TEXAS GENERAL CONDITIONS OF CONTRACT

INVITATION TO BID The Lodge Indoor Pool Deck Chairs

REQUEST FOR SEALED BID PROPOSAL

Please include a business card with updated contact information in the packet.

SANDHILLS COMMUNITY COLLEGE REQUEST FOR PROPOSALS RFP #

Request for Quotation

construction plans must be approved for construction by the City PBZ department.

CITY OF BRENHAM, TEXAS. Invitation for Bid. Purchase and Installation of Forty (40) Ton Air Conditioning Unit

Request for Proposal (RFP) For Installing Fuel Dispensers and Fuel Management System Software Upgrades

City of Forest Park Request for Proposals. Secure Access Control Systems

Request for Proposal (RFP) For Installing Concrete Curb and Gutter 2014 Construction Season

REQUEST FOR PROPOSAL (RFP) ENERGY SAVINGS PERFORMANCE CONTRACTING PROJECT INSTRUCTIONS TO BIDDERS

PURCHASING DEPARTMENT

Invitation To Bid. for

Invitation To Bid. for PURCHASE OR LEASE OF CARDIOVASCULAR EQUIPMENT 2016

City of Forest Park Request for Proposals Concrete Driveway Replacement Fire Station # Jonesboro Rd., Forest Park, Georgia,

Invitation to Bid Instructions to Bidders Bid Sheet Bid Proposal Contract Checklist

REQUEST FOR SEALED BID PROPOSAL

VILLAGE OF LIBERTYVILLE, ILLINOIS 2015 CO-RAY-VAC HEATING SYSTEM

St. Charles City County Library District Invitation for bid HVAC Replacement at Winghaven Branch

City of Forest Park Request for Proposals. Landscape Installation, 803 & 785 Forest Parkway, Forest Park Ga

City of Forest Park Request for Proposals Fence Installation Police Department Firing Range 2020 Anvil Block Road, Forest Park, Georgia,

Johnson City Power Board

BROWNSVILLE NAVIGATION DISTRICT OF CAMERON COUNTY, TEXAS PORT OF BROWNSVILLE. Specifications for Bid WD Motor Grader 2018 Boom Mower (Shredder)

REQUEST FOR PROPOSAL. Specifications and Proposal Documents for One New 2017 SUV 4 x 4

THE CITY OF FOREST PARK PLANNING, BUILDING AND ZONING DEPARTMENT JONATHAN JONES, DIRECTOR 785 Forest Parkway Forest Park, GA 30297

REQUEST FOR SEALED BID PROPOSAL

Sayreville Housing for Seniors Corporation Gillette Manor

LINCOLN UNIFIED SCHOOL DISTRICT CHROMEBOOK BID

City of Portsmouth Portsmouth, New Hampshire Department of Public Works. Plumbing and Heating Repair Services

REQUEST FOR PROPOSALS FOR THE REPLACEMENT OF TRUCK SCALE. for the DUTCHESS COUNTY RESOURCE RECOVERY AGENCY POUGHKEEPSIE, NEW YORK

Request for Quotation

If you have any questions contact Jeff Eady of the City of Forest Park Public Works Department at (404)

Watershed Educational Campaign Project

REQUEST FOR QUOTE (RFQ) # FORESTRY HERBICIDE PURCHASE POSTING DATE: JULY 24, 2018

Request for Quotation

N O T I C E T O B I D D E R S

West Ridge Park Ballfield Light Pole Structural Assessment

INVITATION TO BID. Purchase of 2019 Requirements of Road Materials, as needed

Color Copier/Printer Lease

Transcription:

To All Bidders: Sealed bids will be received until 2:30 p.m. prevailing time, on October 30, 2014 by the Board of Education of Consolidated School District No. 158 of McHenry and Kane Counties, Illinois at the Square Barn Road Campus, District 158 Administrative Center, 650 Academic Drive, Algonquin, Illinois for the following: Fork Truck Bid # 2014-03-5 Proposals complying with the bid documents will be received for the projects until the specified closing time. Bids shall be submitted on or before the specified closing time in an opaque sealed envelope marked Fork Truck Bid # 2014-03-5 on the outside and addressed to: Dr. John Burkey, Superintendent of Schools, Consolidated School District No. 158, Administrative Office, 650 Academic Drive, Algonquin, Illinois 60102. Bids shall be opened publicly and the contents announced at the specified closing time and at the location immediately above. Bids received after stated time will not be accepted and will be returned unopened. All bids submitted shall be valid for a period of at least (60) sixty days from the date of bid opening. The only alterations, which may be allowed, will be those approved by the Board of Education. No immediate decision shall be rendered concerning the bids submitted at time of opening. The Bidder shall be actively engaged in procurement of the materials the School District is presently bidding here-in. All bidders shall have adequate resources to deliver the specified products on-time and per specifications. Each Bidder shall submit with their proposal, a list of no less than five (5) clients, from five different companies, for whom they have successfully conducted business with in the last three years. The Board of Education of Consolidated School District No. 158 reserves the right to reject any or all bids or parts thereof, to waive any irregularities or informalities in the bidding procedures and to award the contracts in a manner serving the best interest of the School District. All bidders must comply with the Illinois Statutory requirements regarding labor and bidding, including Equal Opportunity Laws. All bidders interested in providing a proposal must submit a completed copy of the Intent to Provide Bid Form to the Consolidated School District 158 Operations and Maintenance Office no later than 3:30 pm seven days prior to the bid due date. Bidding documents will be on file and may be obtained from the Consolidated School District 158 website www.district158.org / About D158 / about business opportunities or by calling the office of the Director of Operations and Maintenance, 650 Academic, Algonquin, Illinois 60102, telephone (847) 659-6163, fax (847) 659-6126. Sincerely, Douglas Renkosik Director of Operations and Maintenance Consolidated School District No. 158 650 Academic Drive Algonquin, Illinois 60102 Page # 1 of 11

General Conditions See Instructions to Bidders and General Conditions which is later in this document. When a bidder signs the bid form, the bidder acknowledges having read and agrees to all the conditions and terms listed in this document. In addition, the bidder must sign and include copies of the forms from that document with the bid form for a complete bid. No bid bond is required with this bid. Any interpretation of the proposed documents will be made only by an addendum duly issued by the Director of Operations and Maintenance or the District 158 Superintendent of Schools. A copy of such addendum will be faxed, e-mailed, and/or mailed to each person receiving a set of such contract documents and to such prospective bidders as shall have requested that they be furnished with a copy of each addendum. Failure on the part of the prospective bidder to receive a written interpretation prior to the time of the opening of bids will not be grounds for withdrawal of his proposal. Bidders shall acknowledge receipt of each addendum issued in the space provided on the proposal form. Oral explanations will not be binding. Award will be made by official Board documents. Bidder s order form is not acceptable and can not be used. If bidder who is considering providing a bid for an alternative brand of equipment, bidder shall include performance specifications for the proposed alternative product which demonstrate the alternative products meets the performance ratings listed in this specification. For the bidder's bid to be considered complete, the bidder shall include these performance specifications for any proposed alternative products with the bid. Upon request, bidder shall be able to deliver to the District 158 O&M Office demonstration models of proposed product (, of the type provided for as a part of the bid,) within two days. Summary of Bid Requirements Furnish one new fork truck to School District 158 which meets or exceeds the minimum performance specifications as indicated in this bid specification. For a complete bid, the vendor shall state model number and manufacturer of equipment and supply literature that shows the equipment if your company is quoting a brand other than the ones listed in the specification. Information about guarantees, warranties and service should be included. The bid price should include all freight and handling charges (FOB 13719 Harmony Rd., Huntley, IL 60142. The accessories which are listed shall be from the equipment manufacturer. Alternate brands of accessories will not be accepted. Bidder is not required to bid for all types of equipment listed, but must furnish all accessories listed as a part of the bid price for the specific equipment for which a bid is provided. The fork truck provided must meet the minimum safety standards of the State of Illinois. Bidders must insure that their bid price includes the cost of the particular options as called for in the equipment specifications. As a part of the bid price, bidder shall provide training on operation and maintenance of the equipment delivered to the School District. Training shall include: 1. Delivery of one complete hard copy and one electronic copy of the owner's O&M manuals and parts lists. 2. A minimum of one hour of training for 3 people for each type of equipment delivered to be conducted by a trained factory representative to be conducted at a School District 158 facility to be determined. For a complete bid, the bidder shall provide a copy of the manufacturer s product literature and the manufacturer s product performance specifications for specific make and model of equipment the bidder intends to provide as a part of the bid along with other forms called out in the Instructions to Bidders and General Conditions. Delivery Schedule Successful bidder must be able to deliver the specified product within 90 days of notification of bid award. Failure to deliver a shipment ontime constitutes default by the vendor and gives authority to School District 158 to suspend the procurement process with the bidder, rescind the remainder of the bid from the defaulted vendor, and re-bid the procurement. Site Addresses for delivery is Huntley High School, 13719 Harmony Road, Huntley, IL 60142. Page # 2 of 11

Minimum Product Specifications for Athletic field maintenance Equipment Manufacturer: Model Class Quantity Base Capacity Clark GTX16-TRIPLE Upright Class - I One 3,200 (lbs) Options Included: Category Factory ID Description 1 Battery 61-913 48 Volt System 1 Masts 23-188 Triple Mast 188" Maximum Fork Height 83" Overall Height Lowered 34" Free Lift Standard tilt range 6 B/6 F 1 Forks 51-142 1.38" thick x 4" wide x 42" long Class II Forks 1 Load Backrests 42-004 48" high Load Backrest for 37" wide Carriage 1 Drive Tires 61-630 18 x 7-8 Solid Pneumatic Non-marking Drive Tires 1 Steer Tires 61-915 15 x 4.5-8 Solid Pneumatic Non-marking Steer Tires 1 Auxiliary Valves 61-421 Auxiliary Valve - Single for two hoses (3 spool, 1 lever) 1 Lights 63-403 Amber Strobe Light Page # 3 of 11

INSTRUCTIONS TO BIDDERS AND GENERAL CONDITIONS 1. GENERAL A. Bids must be submitted on the standard bid form which is enclosed. B. Facsimile copies of bids are not accepted C. Bids must be submitted in a sealed envelope. Bids must be labeled according to the Instructions on page one of this document. E. Bids received after the scheduled date and time of the bid opening will not be opened or read aloud. F. Supply and/or equipment bid prices should include delivery charges for shipping to the School District. G. All bids must be typed or written in pen. Pencil is not acceptable. BIDS WRITTEN IN WITH PENCIL WILL BE REJECTED. 2. EXCEPTIONS It is the intention of the School District to have a fair and open bid process. Bidders are not required to bid the specific manufacturer and model number shown in the bid documents. But any exceptions to these conditions or deviations from the specifications must be submitted in writing and attached to the bid form. If any items bid are for products other than the specified manufacturer and model number, the Vendor MUST: 1.) Include Literature with a picture, specifications, manufacturer name and model/part #. 2.) Clearly specify on the Bid Form that the bid price is an alternative is bid. Failure to do any of the above will constitute a No Bid item. In the event of any claim by any unsuccessful bidder concerning or relating to the issue of equal or better or equal to, the unsuccessful bidder agrees, at his own cost, to defend such claim and agrees to hold the District harmless from any loss or damage arising out of this transaction. 3. FIRM BID PRICES Prices, terms and conditions must be firm for a period as specified on page 1 of this bid document otherwise agreed to by DISTRICT 158 and the bidder. 4. EXEMPTION FROM TAXES School District 158 is exempt from Federal, State, and Municipal taxes. 5. INVESTIGATION OF BIDDERS The list of references, as required on page 1 of this bid document, shall each be for different customers of the bidder. The Board of Education reserves the right to reject any bid if it is determined that the bidder is not qualified to provide the services described in the specifications. 6. RESERVATION OF RIGHTS BY THE DISTRICT The Board of Education reserves the right to reject any or all bids and to award the bid in the best interest of the District. 7. DEPARTMENT OF HUMAN RIGHTS REGULATIONS All bidders must abide by and attest to the fact that they are in compliance with the Illinois Human Rights Act as amended effective July 1, 1993 (formerly the Fair Employment Practice Commission). The D.H.R. (formerly F.E.P.C.) number must be on the bid form. Bidders who do not have a D.H.R. number can satisfy this requirement by signing the enclosed Certificate of Compliance and submitting it with the bid. 8. INSURANCE REQUIREMENTS a. The successful bidder shall expressly bind himself/herself to defend and save the District harmless from all suits or actions of every name and description including Scaffolding Act Liability. Successful bidder shall carry insurance, in company or companies acceptable to the District, for Worker s Compensation, Commercial General Liability, and Automobile liability. Page # 4 of 11

b. Each bidder shall submit as part of the bid, a certification of insurance in force to meet the above specifications. That certificate shall name CONSOLIDATED SCHOOL DISTRICT 158 as an additional insured and shall state that all insurance listed above is primary. CONSOLIDATED SCHOOL DISTRICT 158 shall be notified 30 days prior to any material change in the insurance. c. Workman's Compensation - Statutory - meet minimum requirements for State of Illinois work. d. Comprehensive General Liability Insurance: The successful bidder shall maintain at all times during the contract Comprehensive Liability Insurance (including Broad Form Property Damage) with limits for combined bodily injury and property damage of not less than $1,000,000 for each occurrence and not less than $1,000,000 aggregate. e. Owner s Protective Liability: The successful bidder shall maintain at all times during the contract Owner s Protective Liability with limits for combined bodily injury and property damage of not less than $1,000,000 for each occurrence and not less than $1,000,000 aggregate. f. Comprehensive Auto Liability Insurance: The successful bidder shall maintain at all times during the contract Comprehensive Auto Liability with limits for combined bodily injury and property damage of not less than $1,000,000 for each occurrence and not less than $1,000,000 aggregate. A copy of the Certificate of Insurance shall be furnished to the Director of Operations & Maintenance before the work begins. CERTIFICATE OF INSURANCE FORM The following wording must appear in the section, Description of Operations/Locations/Vehicles/Restrictions/Special Items: School District #158 is named as additional insured as their interests may appear with respect to General Liability. Work cannot begin nor will any payments be issued until the Certificate of Insurance has been received with School District #158 being named as additional insured. 9. SIGNATURE: CONSTITUTES ACCEPTANCE The signing of the bid form shall be construed as acceptance of all the provisions contained herein. 10. BID BOND Bid Bond is not required on this particular project. 11. PERFORMANCE BOND AND PAYMENT BOND A Performance and a Labor and Material payment Bond is not required on this project. 12. PAYMENTS The School District will commence the processing of payment upon receipt of a complete shipment of supplies and/or materials specified provided the delivered goods match specification and are not damaged. The time required for the School District #158 processing of payments is less than 45 days. The deadline for receiving invoices is the last day of the month. 13. Bid Summaries will be forwarded to all bidders within one week after the Board of Education acts on the bids. Any Bid Bonds and Bid Security checks will be returned to the unsuccessful bidders at that time. Any bid security checks form successful bidders shall be returned upon receipt of the specified goods. FORMS TO BE SUBMITTED The DISTRICT 158 Intent to Provide Bid Form (later in this specification) must be completed, signed and submitted no later than due date listed on the form. The following DISTRICT 158 forms (copies attached) must be completed, signed and submitted with your bid: 1. Certificate of Eligibility To Bid. 2. Certificate of Compliance To The Illinois Department of Human Rights. 3. Hold Harmless Agreement 4. Reference List Intent to Provide Bid Form Page # 5 of 11

This form acknowledges receipt of this RFP and states whether the supplier intends to submit or not submit a Bid. The District requires a response, to this section, from all potential bidders receiving this Bid Specification no later than 3:30 p.m. seven days prior to the bid due date. Company Name/Address: Supplier Contact (Please list main contact and alternate): NAME PHONE NUMBER FAX NUMBER E-MAIL ADDRESS We DO plan to submit a proposal for this project. We DO NOT plan to submit a proposal We would appreciate an indication of the reason(s) for declining to submit a proposal (if applicable): Authorized Signature Printed Name Date Title Bidders shall return this form to the attention of Doug Renkosik at the CSD 158 Operations and Maintenance Office via fax (847) 659-6126 AND/OR email to drenkosik@district158.org and jwilhelm@district158.org no later than due date listed on page one of the bid form. Page # 6 of 11

BID FORM BF page 1 of 5 TO: SCHOOL DISTRICT #158 D.H.R. # 650 Academic Drive Algonquin, IL. 60102 FROM: FOR: Fork Truck (Company Name) BASE BID delivered price including all options and accessories as stated in the bid specification Fork Truck one each $ FOB 13719 Harmony Rd., Huntley, IL 60142 Equipment to be provided with bid price above Manufacturer Model Attached with this bid are... Product literature - from product manufacturer Performance Specifications - from product manufacturer Certificate of Eligibility To Bid.-School District for later in the specification Certificate of Compliance To The Illinois Department of Human Rights - School District for later in the specification Hold Harmless Agreement- School District for later in the specification Reference List - School District for later in the specification Bidder agrees to complete work within weeks after contract is awarded Addendum(s) No(s) thru have been received and are duly noted If Bidder Product deviates from specifications in any manner, the Bidder must spell out specific deviations on attachment to bid. I have carefully examined the instructions and specifications and have examined the site where the work is to take place. If awarded a contract within sixty (60) days, I agree to furnish all labor and materials required to complete the work described in these documents in accordance with the terms that have been outlined. Bidder's Name Address By (Sign Name) Title City, State Zip Code ( ) ( ) Telephone No. Fax No. Page # 7 of 11

BID FORM BF page 2 of 5 CERTIFICATE OF ELIGIBILITY TO BID (contractor), pursuant to Section 33E-11 of the Illinois Criminal Code of 1961 as amended, hereby certifies that neither (he, she, it) nor any of (his, her, its) partners, officers, or owners of (his, her, its) business has been convicted in the past five (5) years of the offense of bidrigging under Section 33E-3 of the Illinois Criminal Code of 1961 as amended and that neither (he, she, it) nor any of (his, her, its) partners, officers or owners of (his, her, its) business has ever been convicted of the offense of bid-rotating under Section 33E-4 of the Illinois Criminal Code of 1961 as amended. Date Name of Contractor/Company Street Address City, State, Zip Title of Officer Name of Officer (Please Print) Signature of Officer BID FORM Page # 8 of 11

BF page 3 of 5 CERTIFICATE OF COMPLIANCE TO THE ILL. DEPARTMENT OF HUMAN RIGHTS REGULATIONS For this bid to receive consideration by the Board of Education of School District #158, Algonquin, Illinois, the following certificate must be signed by an official of your company and returned with your bid. This is to certify that our company is in compliance with the provisions of the Illinois Department of Human Rights Regulations. Signed: By: Signature Printed Name Title: Date: Page # 9 of 11

BID FORM BF page 4 of 5. HOLD HARMLESS AGREEMENT By signing this Hold Harmless Agreement, the bidder certifies that to the fullest extent permitted by law, the bidder agrees to defend, pay in behalf of, and hold harmless Consolidated School District 158 and its elected and appointed officials, employees and volunteers and others working in behalf of Consolidated School District 158; against any and all claims, demands, suits, loss, including all costs connected therewith, for any damages which may be asserted, claimed or recovered against of from Consolidated School District 158, its elected and appointed officials, employees, volunteers and others working in behalf of Consolidated School District 158, by reason of personal injury, including bodily injury and death; and/or property damage, including loss of use thereof, which arises out of or is in any way connected or associated with this contract. Company Name By (Sign Name) Address Title Sworn and subscribed on the day of, 20, before me, notary public, appointed in County for the State of IL Signature of Notary Name Typed or Printed (seal) My commission expires: Month Day Year City of Residence County Page # 10 of 11

BID FORM BF page 5 of 5 Name of Contractor (Bidder) REFERENCE SHEET See requirements in Section 5. Investigation of Bidders earlier in the document for special requirements. 1. Name Address City Contact Person Telephone 2. Name Address City Contact Person Telephone 3. Name Address City Contact Person Telephone 4. Name Address City Contact Person Telephone 5. Name Address City Contact Person Telephone Page # 11 of 11