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Exhibit D <br />~rw <br /> <br />,r <br />QUOTATION FORM <br />Project ~/N'C- ypuS~ ~~L~G~}-Tifl~ <br />Location ~1/Gb./~ ~~Pvr <br />City/State/Zip .~~'~N~ G~ `~7~~7 ) <br />Page 1 of 2 <br />Provide fixed price quotations on this form for the work described on the attached Request for Quotation. <br />Quote shall be signed with firm name and official signature. Quotes submitted by FAX shall be <br />followed up by original mailed to the address on the Request For Quotation. <br />Contractor is required to furnish a current certificate of Worker's Compensation Coverage, certificate of <br />General Liability Insurance and certificate of Automobile Insurance prior to beginning the work <br />described. <br />The undersigned hereby proposes to furnish all labor and material and to perform all work as required by <br />the City of Eugene Request For Quotation, dated October 23rd, 2003, for the fixed sum of <br />BASE QUOTE: $ ~~ a ~ ~ ~ ~ ; <br />TIME OF COMPLETION <br />The undersigned agrees, if awarded Contract, to fully complete the Work prior to November 15`x, 2003. <br />ADDENDA <br />The undersigned acknowledges receipt of and agrees to be bound by addenda numbered through <br />inclusive. <br />BIDDER' S STATEMENT <br />The undersigned, by submitting a Quote, represents that: <br />A. The Bidder has visited the site, become familiar with the extent and local conditions under which <br />the Work is to be performed and has correlated the Bidder's personal observations with the <br />requirements of the Request for Quotations. <br />B. The Quote is based upon the experience, certification, materials, equipment, and systems required <br />by the Request for Quotations without exception. <br />C. The undersigned certifies that the Quote has been arrived at independently and has been submitted <br />without any collusion designed to limit independent bidding or competition. <br />D. The undersigned certifies to comply with provisions of ORS 279.350. <br />E. The undersigned certifies to have in-place a Qualifying Employee Dnig Testing Program, pursuant <br />to ORS 279.312. <br />Company Name. <br /> <br />