2010-73 }
EXHIBIT "A"
CITY OF FERNANDINA BEACH
BID FORM
BID NUMBER: 08-22
PRODUCT OR SERVICE: POLYMER CONCENTRATE
I hereby submit the following bid for POLYMER CONCENTRATE. Price is in accordance
with the Specifications and the General Conditions on the Invitation to Bid as provided.
BID Amount: $ 1.10 /Lb.
Clarifloc SE -1054
Name: Polydyne Inc.
Federal Taxpayer ID #: 34 1810283
Mailing Address: P.O. 'Box 279
City, State, & Zip Code: Riceboro, GA 31323
Telephone Number: (912) 880 -2035 F ax: (912) 880 -2078
Submitted By: /64.4"4-14-c..— ../
Lawrence D. Grizzle
Title: Business Manager
Remarks:
* * * * * * * * * * * * * * * *IF NOT SUBMITTING A BID, IN ORDER TO REMAIN ACTIVE IN OUR
BID VENDOR RECORDS, PLEASE COMPLETE THIS FORM MARKED "NO SUBMIT"
WITH REASON, AND FAX TO 9 04 - 277 - 7317 * * * * * * * * * ** **
•
General Conditions for ITB #08 -22
Polymer Concentrate
Page 6 of 9
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FINANCE DEPARTMENT
RECIEEZ
June 15, 2010 Lt JUN 1. 7 2011!
B Y:
Polydyne, Inc
PO Box 279
Riceboro GA 31323
Re: Annual Bid Extension 2010-2011
Commodity: Polymer Concentrate
Attached you will find the documents that need to be signed and returned to me before we can apply to the City
to extend the annual agreement for Polymer Concentrate .
• Extension of Bid Based on Mutual Agreement
• Exhibit B — Public Entity Crimes
• Exhibit C — Drug Free Workplace Certification
You will also need to send in a current Certificate of Insurance reflecting the City of Fernandina Beach as the
Additional Insured: The COI should cover the annual period of October 1, 2010 — September 30, 201 1.
Should you have any questions please give me a call at 904 - 277 -731 1 x2035.
S
6
Deni Murray
Purchasing Agent
204 Ash Street'
Fernandina Beach, FL 32034
(904) 277 -731 1
204 Ash Street • Fernandina Beach, FL 32034 - 4230.904 277 -7311 • Fax 904,277 -7317 • www fbfl us
Equal Opportunity Employer