Competitive Sealed Proposal (CSP) CSP Number: 150311 Title: Athletic, Training, PE, Dance and Cheer, Award Jacket, and Awards uniforms, apparel, accessories, supplies, equipment, and monogramming/embroidery services Due Date: March 11, 2015 Prior to: 3:00 pm Mail or deliver complete CSP package to: Denton Independent School District Purchasing Department 1213 N. Locust St. Denton, TX 76201 For additional information, please contact the person listed below. All questions must be submitted in writing (email preferred) and received on or before seven (7) calendar days prior to the opening date. . Cheryl Farmer, Asst. Purchasing Agent cfarmer@dentonisd.org PROPOSER IDENTIFICATION (Please print information clearly) Firm Name: Date: Address: Phone: Fax: City/St/Zip: Email: You MUST sign the CSP Response Form on page 8 in order for your CSP to be accepted. 1 CSP 150311 for Athletic, Training, PE, Dance and Cheer uniforms, apparel, accessories, supplies, and equipment, Letter Jackets, Awards and Monogramming / Embroidery Services The Denton Independent School District (referred to as the “District” from this point forward) is soliciting responses to this Competitive Sealed Proposal (CSP) offering Percentage Discounts off catalog prices, published list prices or fair market value for Athletic, Training, PE, Dance and Cheer - uniforms, apparel, accessories supplies, and equipment, Letter Jackets, Awards and Monogramming / Embroidery Services. RESPONDENTS ARE CAUTIONED TO READ THE INFORMATION CONTAINED IN THIS CSP CAREFULLY AND TO SUBMIT A COMPLETE RESPONSE TO ALL REQUIREMENTS AND QUESTIONS AS DIRECTED. Your company is invited to submit a proposal no later than 3:00 pm CST, March 11, 2015 to Cheryl Farmer, Assistant Purchasing Agent, Denton ISD, 1213 N. Locust St., Denton, TX 76201. PROPOSALS SUBMITTED AFTER THE SPECIFIED DATE AND TIME WILL NOT BE ACCEPTED. All proposals are to be checked in at the Purchasing Department office. Proposals not checked in properly may cause disqualification. All questions concerning the CSP must be submitted in writing on or before seven (7) calendar days prior to the opening date to Cheryl Farmer, Assistant Purchasing Agent at cfarmer@dentonisd.org. List the CSP name and number in the Subject line. The bid documents can be obtained from the Purchasing Department at 1213 N. Locust St., Denton, TX. 76201 OR on the Purchasing Department page of the Denton ISD website at www.dentonisd.org. All addenda issued by Denton ISD prior to the time that responses are received shall be considered part of the CSP and Respondent shall be required to consider and acknowledge receipt of such in the response. Firms receiving this CSP other than directly from Denton ISD are responsible for obtaining any addendum (amendment) in the event an addendum is issued. The CSP materials submitted must be enclosed in a sealed envelope (box or container) clearly labeled on the outside with the proposal number CSP 150311. Faxed or emailed copies will not be accepted. Pricing will not be read aloud at the time of opening. A committee will convene to review the proposals and rank them according to the specified criteria. Results will be posted on the purchasing department web page after a recommendation has been sent to the governing body for consideration. The District will award the proposal to one or more vendors to establish a preferred vendor list for these products. Purchases will be made on an as-needed basis for the term of the proposal. The District does not award contracts on lowest pricing alone. The District reserves the right to accept or reject any and /or all proposals, to waive any technicalities, to be the sole judge of quality and equality and to accept the proposal that is in the best interest of the district. The District reserves the right to award each item separately or as a whole, or as is in the best interest of the district, unless bidder states otherwise. The District also reserves the right to be the sole judge as to the definition of “best interest”. 2 Instructions to Proposers To be considered for award of this solicitation, all pages requiring signature plus any/all attachments, must be completed with all requested information, signed and returned sealed in an envelope or other appropriate package adequate to conceal and contain the contents prior to the CSP date and time. The Proposer is strongly encouraged to read the entire CSP document prior to submitting response. Failure to provide the information requested in its entirety may be grounds for disqualification of CSP. The CSP response must be signed by an individual authorized to contractually bind the company submitting the CSP. A failure to sign the CSP could cause it to be rejected as non-responsive. The CSP must include full firm name and address of Proposer, the title or authority to bind his/her firm in a contract and contact information. A Signature Sheet is included in this packet. Vendors that do business with a school district are required to file a questionnaire to identify any potential conflicts of interest. The CONFLICT OF INTEREST QUESTIONNAIRE is attached in this proposal. Possession of fire arms, alcohol and/or drugs, even in vehicles, is strictly prohibited on school district property. Use of any tobacco products is not permitted on school property. The District reserves the right to acquire reasonable amount of additional goods or services, as listed on this CSP, subject to verification of the same or lower prices and conditions on CSP. The District reserves the right to extend this solicitation 60 days past end of the contract term should it be determined that doing so would be in the best interest of the District. Scope of Work The Denton ISD intends to purchase Athletic, Training, PE, Dance and Cheer - uniforms, apparel, accessories, supplies, and equipment, Letter Jackets, Awards and Monogramming / Embroidery Services from date of governing approval through March 31, 2017. Discount(s) must remain in effect from the time of board approval through March 31, 2017. The district currently has three high schools, seven middle schools and twenty two elementary schools. A fourth high school and twenty third elementary school will open the fall of 2016. An eighth middle school is scheduled to open in 2017. The District intends to select primary and secondary vendors for each sport area as well as to for dance and cheer apparel and accessories, for Letter Jackets and Awards based upon the results of the evaluation criteria listed in this proposal. The District will accept only the vendors the District believes will give the best overall value and service. The District reserves the right to: Be the sole judge as to the definition of best overall value and service. Determine, after proposal evaluation, the number of primary and/or secondary vendors that will be awarded to any area. Be the sole judge as to how the evaluations will be used to establish the primary and/or secondary vendors for all areas. Remove vendors at any time during the contract term and Add vendors at the beginning of any contract year upon governing body approval. Any additions will not affect the contract with existing vendors. 3 Purchases will be made on an as-needed basis. No vendor will be guaranteed any quantity of product or service or amount spent. No vendor will be guaranteed a place as primary or secondary vendor. Some vendors, after proposal evaluation, may be rejected for all areas. Standard Terms and Conditions All items covered by this CSP shall be delivered F.O.B Destination Denton ISD, from point of assembly to the District location(s) specified on each purchase order. The District shall not be liable for any deliveries of merchandise unless same has been received at the specified delivery location within the Denton Independent School District, inspected and accepted as in full compliance with the Specifications. Risk of theft, destruction, loss or damage to any work, materials, shipment, or deliveries will be borne exclusively by the successful Proposer until after the District completes its inspection and acceptance of said work, material, shipments, or deliveries; the burden and cost of insurance against such risks shall be assumed by the successful Proposer. Deliveries will be made only upon authorization of the Denton ISD, and shall be made if, as, and when required and ordered by the District, at such intervals as directed by the District. It is important that each supplier understand the following information: All purchases made by the District will be made via Denton ISD purchase order. Do not provide goods/services absent a bona fide, signed purchase order. Do not provide good/services exceeding the quantities contained on the purchase order. The District will only pay invoices which match the purchase order description, quantity, and price. Deliveries shall be to the location identified in each Purchase Order. Each proof of delivery shall list the Denton ISD purchase order number, exact quantity delivered, back orders (if any) and number of packages/boxes/pallets. Payment will be made after all purchases are completed and properly invoiced by purchase order number. Invoices must include the Purchase Order number and the ship to location. The District is exempt from Federal Excise tax. The Tax Exemption Certificate will be furnished upon request. All invoices are to be sent to: Denton Independent School District Accounts Payable Department P.O. Box 2387 Denton, TX 76202 Failure of the successful Bidder(s) to notify the District sufficiently in advance of the inability to complete the order within a reasonable time frame and with acceptable reason, shall give the District the option of cancelling the Purchase Order and purchase from another source. Denton ISD is a member of various purchasing cooperatives (inter-local agreements). The District reserves the right to purchase goods and/or services in this CSP through an inter-local agreement, if it is deemed that the interlocal agreement is in the best interest of the District. Denton ISD reserves the exclusive option to purchase through Open Market advertisement bulk quantities of all products listed herein when determined to be in the District’s best interest. The District shall be the sole judge as to “bulk quantities”, District’s best interest” and “reasonable time frame”. Special Terms and Conditions listed below are to be used to set a minimum standard. The District does not want inferior substitute merchandise. Whenever an article or material is defined by describing a proprietary product or 4 by using the name of a manufacturer, the term “or equal” if not inserted, shall be implied. The specified article or material shall be understood as indicating the type, function, minimum standard of design, efficiency and quality desired and shall not be construed as to exclude other manufactured products of comparable quality design, and efficiency. Any “equal to” or alternative product to the specifications must clearly state the brand name and description. Failure to provide proper information with this document may result in disqualification. The District reserves the right to accept or reject any and/or all proposals, to waive any formalities and to award this proposal in the best overall interest of the District. The District reserves the right to make final decisions as to comparable items. Items submitted as “equal to” may be returned at vendor expense if deemed otherwise. The District, in order to implement Senate Bill 1340, may give Preference for Recycled Products, defined as a product made of recycled materials that meet specification as to quality and quantity. The District shall regularly review and revise procurement procedures and specification for the purchase of goods, supplies, equipment and materials to: Eliminate procedures and specifications that explicitly discriminate against products made of recycled materials. Encourage the use of products made of recycled materials. Any product quoted in this proposal that contains recycled materials must be identified by item number and the percentage of post-consumer waste, industrial waste or hazardous waste used in place of a raw or virgin material in manufacturing. This identification list must be attached to this proposal. Special Terms and Conditions To be considered for award of this solicitation, all pages requiring signature, plus any/all attachments, must be legible and completed with all requested information, signed and returned sealed in an envelope or other appropriate package adequate to conceal and contain the contents prior to the CSP date and time. Required documents are: Signature Sheet Proposal and Deviation Non-Collusion, Criminal Background Check and Felony Conviction Notification Debarment or Suspension Certification Senate Bill 9 EPCNT – Purchasing Cooperative / Interlocal Agreement (Optional) Conflict of Interest Vendor Data Form References Additional documents to be included in submission HUB certification documentation - if applicable W-9, Tax Payer Identification Number & Certification Product Catalog (Not required to be considered) 5 The District is soliciting responses to this Competitive Sealed Proposal (CSP) offering Percentage Discounts off catalog prices, published list prices or fair market value. Any product not included in the discount being submitted must be listed on the bid form. Failure to indicate exclusions will require those products to be included in the discount. Include a current catalog of the products available to Denton ISD, to which the percentage discount shall apply. Manufacturer documented price increases will be recognized by Denton ISD during the contract period. The percentage discount shall be consistent for all products. You may submit more than one catalog. Proposers who do not have a catalog, must include a list of items you wish to sell to the district and the discount for each. Shipping and handling charges are to be included in your discount. Delivery shall be made during normal school working hours, 8:30 am to 4:00 pm., Monday through Friday, excluding school holidays, unless arrangements are made to the contrary in advance. Any deviation must be noted in the Deviation page. By submitting a proposal to the District, the vendor agrees to waive and does waive any claim or cause of action against the Denton ISD, its Trustees, agents and employees arising out of or in connection with: the review of, evaluation of, and application of criteria for selection to the proposal; the recommendation of any proposal to the Board of Trustees, the selection or approval of any proposal by the Trustees on behalf of the District; the awarding of any contract by the Trustees for services included in the proposal; the waiver of any requirement contained in the Proposal; any determination of best value to the District by the District, its’ Trustees, Agents or employees from the proposals submitted to the district in response to the Proposal. Evaluation Criteria In evaluating bids/proposals submitted and per the Texas Education Code 44.031(b), the following considerations shall be taken into account to determine the best value for the District: 1. 2. 3. 4. 5. 6. the purchase price; the reputation of the vendor and of the vendor’s goods or services; the quality of the vendor’s goods or services; the extent to which the goods or services meet the district’s needs; the vendor’s past relationship with the district; the impact on the ability of the district to comply with laws and rules relating to historically underutilized businesses; 7. the total long-term cost to the district to acquire the vendor’s goods or services; 8. for a contract for goods and services, other than goods and services related to telecommunications and information services, building construction and maintenance, or instructional materials, whether the vendor or the vendor’s ultimate parent company or majority owner: a. has its principal place of business in this state; or b. employs at least 500 persons in this state; and 9. any other relevant factor specifically listed in the request for bids or proposals. 6 The District does not award contracts on pricing alone. The District reserves the right to award the contract to the vendor(s) who offers the proposal with the best value, and in the best interest of the district. The District also reserves the right to be the sole judge as to the definition of “best value” and “best interest of the district”. The District reserves the right to conduct any test, evaluations or comparisons it deems necessary to complete the evaluation process. Contract Term The term of this contract will be from the date of governing body approval through March 31, 2017. The district may upon governing body approval, extend this CSP for (1) one additional year ending March 31, 2018. The District has the option to extend this CSP at the end of any contract term for up to 60 days if determined to be in the best interest of the District to ensure the availability of products and/or services. All purchase orders dated and issued within these dates will be subjected to the terms and conditions of this CSP. Proposal pricing must remain firm for the term of the contract for the proposal to be considered. Denton ISD reserves the right to remove vendors at any time during the contract term. Denton ISD also reserves the right to add vendors at the beginning of any new contract year, upon governing body approval, as part of the contract extension process. Any additions will not affect the contract with existing vendors. 7 Signature Sheet We, the undersigned, have read and fully understand the specifications and conditions relating to this document. SUBMITTED BY: FIRM: _____________________________________________ (OFFICIAL FIRM NAME) MUST BE SIGNED IN INK TO BE CONSIDERED RESPONSIVE BY: _____________________________________________ (Original Signature) Name: ____________________________________________ (Typed or Printed Name) Title: ____________________________________________ _______________________________ (Typed or Printed Title) (Date) Address: ______________________________________ City/State/Zip: ______________________________________ Phone #: ______________________________________ Fax #: __________________________ Email: ______________________________________ NOTE: Submit copy of Proposer’s Taxpayer Identification #: _____________________________ current W-9 Form I hereby acknowledge receipt of the following addenda (if applicable) which have been issued and incorporated into the CSP Document. (Please initial in ink beside each addenda received.) Addendum No. 1 _________ Addendum No. 2 __________ Addendum No. 3 _________ Addendum No. 4 __________ 8 PROPOSAL / DEVIATION FORM Firm Name: __________________________________________________________________________ Representative Name: __________________________________________________________________ (Original Signature) Representative Name: __________________________________________________________________ (Typed or Printed) Phone #: _______________________________ ___ Fax #: _________________________________ E-mail Address: ____________________________ Date: Discount being Proposed: Exceptions: ________________________________ ________________ % ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Shipping / Handling / Freight charges are to be included in discount. Any deviation must be included below: (includes drop-ship items) _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ Check below desired areas for consideration: Basketball Baseball Cross Country Football Golf Soccer Softball Swimming Tennis Track Volleyball 9 Training PE Cheer and Dance Apparel and accessories Letter Jackets Trophies / Awards General monogramming / embroidery List all Purchasing Cooperative your company participates in. (Ex. Buyboard, TCPN, EPCNT, etc.) ____________________________________________________________________________________ ____________________________________________________________________________________ Is your company Sole Source for any product or service? _______ Yes ______ No. If so, include a sole source letter with the proposal. List Catalog Names, Dates and Discount % of each being represented: Title Date Discount % List Brand names included in Discount: _____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ 10 NON-COLLUSION STATEMENT The undersigned affirms that he/she is duly authorized to execute this CSP, that this company, corporation, firm, partnership or individual has not prepared this CSP in collusion with any other Proposer, and that the contents of this CSP as to prices, terms or conditions of said CSP have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of the CSP. Firm Name: _________________________________________________________________ Address: _________________________________________________________________ City/State/Zip: _________________________________________________________________ Phone #: _______________________ Fax #: ______________________ Name of Authorized Official: ____________________________________________________ (Typed or clearly printed) Signature of Authorized Official: ____________________________________________________ Position / Title: ___________________________________ Date Signed: ______________ Firm hereby assigns to purchaser any and all claims for overcharges associated with this RFCSP which arise under the antitrust laws of the United States, 15 USCA Section 1 and which arise under the antitrust laws of the State of Texas, Business and Commerce Code, Section 15.01. CRIMINAL BACKGROUND CHECK AND FELONY CONVICTION NOTIVICATION CRIMINAL BACKGROUND CHECK Proposer will obtain history record information that related to an employee, applicant for employment, or agent of the Proposer if the employee, applicant, or agent has or will have continuing duties related to the contracted services; and the duties are or will be performed on school property or at another location where students are regularly present. The Proposer certifies to the Denton ISD before beginning work and at no less than an annual basis thereafter, that criminal history record information has been obtained. Proposer shall assume all expenses associated with the background checks, and shall immediately remove any employee or agent who was convicted of a felony or misdemeanor involving moral turpitude, as defined by Texas law, from Denton ISD’s property or other location where students are regularly present. Denton ISD shall be the final decider of what constitutes a substantial failure. If the Proposer is the person or owner or operator of the business entity, that individual may not self-certify regarding the criminal history record information and its review, and must submit original evidence acceptable to the District with this Agreement showing compliance. 11 FELONY CONVICTION NOTIFICATION State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (a), states, “a person or business entity that enters into a contract with a school district must give advance notice to the District if the person or owner or operator of the business entity has been convicted of a felony.” The notice must include a general description of the conduct resulting in the conviction of a felony. Subsection (b) states, “a school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction.” The District must compensate the person or business entity for services performed before the termination of the contract. THE FELONY CONVICITON NOTICE IS NOT REQUIRED OF A PUBLICLY-HELD CORPORATION. Firm Name: __________________________________________________________________________ Name of Authorized Company Official: ____________________________________________________ (Typed or clearly printed) A. My firm is a publicly-held corporation; therefore this reporting requirement is not applicable: Signature of Company Official: ____________________________ Date: ______________ B. My firm is not owned nor operated by anyone who has been convicted of a felony. Signature of Company Official: ____________________________ Date: ______________ C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony: Name of Felon(s): _____________________________________________________________ Details of Conviction(s): _________________________________________________________ ______________________________________________________________________________ Signature of Company Official: ___________________________ Date: ______________ NOTE: Name and signature of company official should be the same as on the Non-Collusion Statement. Vendor is responsible for the performance of the persons, employees and/or sub-contractors Vendor assigns to provide services for the Denton ISD pursuant to this CSP on any and all Denton ISD campuses or facilities. Vendor will not assign individuals to provide services at a Denton ISD campus or facility who have a history of violent, unacceptable, or grossly negligent behavior or who have a felony conviction, without the prior written consent of the Denton ISD Purchasing Department. 12 DEBARMENT OR SUSPENSION CERTIFICATION FORM Non-Federal entities are prohibited from contracting with or making sub-awards under covered transaction to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement of goods or services equal to or in excess of $100,000. Vendors receiving individual awards of $100,000 or more and all sub-recipients must certify that the organizations and its principals are not suspended or debarred. By submitting this offer and signing this certificate, you (the Vendor): (1) Certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency under the Federal OMB, A-102, common rule. Firm’s Name: ________________________________________________________________________ Address: ________________________________________________________________________ City/State/Zip: ________________________________________________________________________ Telephone #: _________________________________ Authorized Company Official’s Name: _____________________________________________ (Typed or printed) Title of Authorized Representative: _____________________________________________ (Typed or printed) Signature of Authorized Company Official: _____________________________________________ Date Signed: _____________________________________________ 13 Model SB 9 Contractor Certification Form Criminal History Record Information Review of Certain Contract Employees Introduction: Texas Education Code Chapter 22 requires service contractors to obtain criminal history record information regarding covered employees and to certify to the District that they have done so. Covered employees with disqualifying convictions are prohibited from serving at a school district. Definitions: Covered employees: Includes all employees of a contractor (to include any subcontractors and/or independent contractors) who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying conviction: One of the following offenses, if at the time of the offense: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or c) an equivalent offense under federal law or the laws of another state. On behalf of ___________________________________________________ ("Name of Contractor"), I First Name: _________________________ Last Name:______________________________________ Address: ________________________________________ City: _____________________State:_____ Zip: _______ Telephone: ________________Fax: _____________ Email:_______________________ Certify that [check one]: [ ] None of Contractor’s employees are covered employees, as defined above. Or [ ] Some or all of the Contractor's employee are covered employees. If this box is selected, I further certify that: Contractor has obtained all required criminal history record information, through the Texas Department of Public Safety, regarding its covered employees. None of the covered employees has a disqualifying conviction. Contractor has taken reasonable steps to ensure that its employees who are not covered employees do not have continuing duties related to the contract services or direct contact with students. If Contractor receives information that a covered employee has a disqualifying conviction, Contractor will immediately remove the covered employee from contract duties and notify the District in writing within three (3) business days. Upon request, Contractor will make available for the District's inspection the criminal history record information of any covered employee. If the District objects to the assignment of a covered employee on the basis of the covered employee's criminal history record information, Contractor agrees to discontinue using that covered employee to provide services at the District. Noncompliance by the Contractor with this certification may be grounds for contract termination. __________________________________________ Signature ____________________________ Date 14 INTERLOCAL AGREEMENT CLAUSE Several governmental entities around the Denton Independent School District have indicated an interest in being included in this contract. Should these governmental entities decide to participate in this contract, would you (the vendor) agree that all terms, conditions, specifications, and pricing would apply? Yes __________ No __________ If you (the vendor) check yes, the following will apply: Governmental entities utilizing Internal Governmental contracts with the Denton Independent School District will be eligible, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation. All purchases by governmental entity other than Denton Independent School District will be billed directly to that governmental entity and paid by that government entity. Denton Independent School District will not be responsible for another governmental entity’s debts. Each governmental entity will order its’ own material/service as needed. For information regarding the Educational Purchasing Cooperative of North Texas, please visit their website at the following address: http://www.epcnt.com/INDEX.html Company Name: __________________________________________ (Typed or printed) Title of Authorized Representative: __________________________________________ (Typed or Printed) Signature of Authorized Company Official: __________________________________________ Date Signed: __________________________________________ 15 16 VENDOR DATA FORM 1. For Purchase Orders: ORDERING ADDRESS INFORMATION Company Name: Address: Business Phone: Fax: Contact Person: Email: Does your company accept orders via email? Yes No If yes, what is the ordering email address? 2. For Payments: REMITTANCE ADDRESS INFORMATION Company Name: Address: Business Phone: Fax: Contact Person: Email: 3. For RFQ Notifications: RFQ NOTICES ADDRESS INFORMATION Company Name: Address: Business Phone: Fax: Contact Person: Email: 17 REFERENCES Please provide three (3) references, preferably from school districts, who have used your services within the last three years. Additional references may be required. DO NOT LIST DENTON ISD EMPLOYEES, FORMER OR CURRENT AS REFERENCES. 1. Company Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Business Phone: _______________________________ Fax: __________________________________ Contact Person: _______________________________ Email: __________________________________ Description of project or work completed: _________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 2. Company Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Business Phone: _______________________________ Fax: __________________________________ Contact Person: _______________________________ Email: __________________________________ Description of project or work completed: _________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 3. Company Name: ______________________________________________________________________________ Address: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Business Phone: _______________________________ Fax: ___________________________________ Contact Person: _______________________________ Email: ___________________________________ Description of project or work completed: __________________________________________________________ _____________________________________________________________________________________________ ______________________________________________________________________________________ 18