10% DEPOSIT & PURCHASE FORM
OFFER FORM
ESCAMBIA
Management
& Budget Services Bureau
Property
Lien Program, 2nd Floor, Room 9111
MARCH 2009
Phone No: (850)595-4996
__________________________________________________________________________________________
OFFER
(SHALL
BE COMPLETED BY OFFEROR)
FEDERAL
EMPLOYER IDENTIFICATION NUMBER OR S.S. NUMBER:
______________________________________________
BID
BOND ATTACHED $____________
SEE
EXHIBIT A--AGREEMENT FOR
BIDDER
NAME:
_____________________________________________________
ADDRESS: __________________________________________________________
CITY,
ST. & ZIP:
____________________________________________________
PHONE
NO.: (_____)_________________________________________________
TOLL
FREE NO.: (______)____________________________________________
FAX NO.: (_____)____________________________________________________
I certify that this bid is made without prior understanding,
agreement, or connection with any corporation, firm or person
submitting a bid for the same materials, supplies or equipment,
and is in all respects fair and without collusion or fraud.
I agree to abide by all conditions of this bid and certify
that I am authorized to sign this bid for the bidder and that the
bidder is in compliance with all requirements of the Invitation to
Bid, including but not limited to certification requirements.
In submitting a bid to Escambia County, Florida, the bidder
offers and agrees that if the bid is accepted, the County will
convey, sell, assign or transfer to the successful bidder all
rights, title and interest in items being sold.
_______________________________________________________________
NAME AND
TITLE OF PERSON AUTHORIZED TO SIGN OFFER
(TYPED OR PRINTED)
_______________________________________________
SIGNATURE
OF PERSON AUTHORIZED TO SIGN OFFER
**
Failure to execute this Form binding the bidder's offer shall result in this
bid/proposal being rejected as non-responsive.
_________________________________________________________________________________________
THIS
BID FORM, is submitted to
I
have complied with and otherwise accept the terms included and offer to purchase
the property identified therein for the following amount:
I
further acknowledge the information contained on this Bid Form is true and
correct to the best of my
knowledge
and belief.
BIDDER:
_______________________________________
Printed
Name: ___________________________ Signature:
_______________________________
Address:____________________
____________________________________________________
Telephone
Number: ___________________ Fax
Number: _____________________________
Cell Phone Number: ___________________ E-mail Address: ___________________________