Free 13788.pdf - Indiana

STATE SURPLUS PROPERTY BID SHEET and AFFIDAVIT
(Front)

State of Indiana Department of Administration State Motor Pool Phone 317 232-1378
SF 13788 (R5/6-05)

Sale/Lease Number: Bid Must Be Received By (Date): Time:

Instructions for Bidding
1. Using the Sale Notice, complete on the BACK: Lot Number, Description, Commission Number, Identification Number and Bid Amount. Each item must be bid on separately and separate checks/money orders must be submitted. Refer to the Sale Notice for the percentage of the bid required (if any indicated). For Indiana Governmental Bidders: A) Complete all sections under LOCAL UNITS OF GOVERNMENT in the lower left side below. B) Written authorization must be enclosed with your bid as follows: CHIEF EXECUTIVE OFFICER County Commissioner Township Trustee Mayor Town Board President Superintendent APPROPRIATING BODY County Council Advisory Board City Council Town Board School Board

2.

LOCAL UNIT County Township City Town School Corp.

C) Local Units of Government may enclose a claim voucher or local unit of government check, or submit payment within 30 days. D) Enclose in the Bid Envelope provided the completed Bid Sheet, Authorization letter, claim voucher and/or local unit of government check for each item you bid on. Print your return address on the back of the Bid Envelope. Mail to the address on the Bid Envelope. 3. For Public Bidders: A) Complete all sections under PUBLIC BIDDER in the lower right side below. B) Attach a separate certified check, cashier's check or money order for each item you bid on. The check/money order must be made payable to the State of Indiana. C) Enclose the completed Bid Sheet and check or money order in the Bid Envelope provided. Print your return address on the back of the Bid Envelope. Mail to the address on the Bid Envelope. PLEASE TYPE OR PRINT NEATLY (if we cannot read your writing, your bid will not be considered)

LOCAL UNIT OF GOVERNMENT
Attached or enclosed is: Written approval to purchase from Appropriating Body Written approval to bid from Chief Executive Officer Name of Local Government Unit: Street Address: State: Zip Code: City: Phone Number: Attached or enclosed is: Cashier's Check

PUBLIC BIDDER
Performance Bond Money Order Certified Check 100% of the Bid

% of the Bid amounting to: $ Refer to the Sale Notice for the percentage of the bid required. Name of Public Bidder (Company, Corporation, Person, etc.): Street Address: State: Zip Code: City: Phone Number:

Name and Title of Agent:

Name and Title of Agent (must be the same as signature below):

Non-Collusion Statement The undersigned, being duly sworn on oath says that he/she is the contracting party, or that he/she is the representative, agent, member, or officer of the contracting party, that he/she has not, nor has any other member, employee, representative, agent or officer of the firm, company, corporation or partnership represented by him/her, directly or indirectly, entered into or offered to enter into any combination, collusion or agreement to receive or pay, and that he/she has not received or paid any sum of money or other consideration for the execution of this contract other than which appears upon the face of this contract. I swear or affirm that the information I have provided is correct. I understand that making a false statement on this form may constitute the crime of perjury. The Bidder must sign and date this contract agreeing to the Bid(s) and the Non-Collusion Statement in order for the bid(s) to be valid. Signature: _____________________________________________________________________Date: _____________________

STATE SURPLUS PROPERTY BID SHEET and AFFIDAVIT
(Back) Using the Sale Notice, complete Lot Number, Description, Commission Number, Identification Number and Bid Amount. Each item must be bid on separately and a separate check must be enclosed for each item. PLEASE TYPE OR PRINT NEATLY (if we cannot read your writing, your bid will not be considered)

Lot Number

Description

Commission Number

Identification Number

Bid Amount

The procedures stated on the front must be followed in order for your bid(s) to be considered. Only one person can complete and sign all necessary sections of this document. A determination of awards will be made within ten (10) working days when feasible. All bidders will be notified of the results by mail, only.

THE STATE OF INDIANA HAS THE RIGHT TO REJECT ANY AND ALL BIDS