Jacket:

Title:

Agency:

Bid Opening: at 2:00 PM

504-830 504-831 504-832 504-833 504-834 504-835 504-836 504-837 504-838 504-839 Total Bid Terms Discounted Total

$52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $52,000.00 $520,000.00 1.00% 20 days $514,800.00

Verified by: Mike Sommer 06/14/2021

S&W Manufacturing

Contractor Name

Strapped Jackets 504-830 to 504-839

US MEDICAL OUTPATIENT AND DENTAL TREAT RECORDS

DLA

June 10, 2021
Specifications by MW Jackets 504-830 thru 504-839 Strapped

Reviewed by: MR Page 1 of 11 

SPECIFICATIONS

U.S. Government Publishing Officer (GPO) – Philadelphia

Southampton, Pennsylvania 18966-3820

BID SUBMISSION: Bids shall be opened at 2:00 PM, prevailing Philadelphia, PA time on, Thursday June 10, 

2021 at the U.S. Government Publishing Office, Philadelphia Regional Office. Due to the COVID-19 pandemic, 

this will NOT be a public bid opening.

Any questions before or after award concerning these specifications, email Melita Webb at mwebb@gpo.gov or 

call (215)364-6465, Ext 5.

BIDDERS PLEASE NOTE: Due to the COVID-19 pandemic, the physical office will NOT be open. Based on 

this bidder MUST submit emails bids to bidsphiladelphia@gpo.gov for the solicitation. No other method of bid 

submission will be accepted at this time.

ADDITIONAL EMAILED BID SUBMISSION PROVISIONS: The Government will not be responsible for any 

failure attributable to the transmission or receipt of the emailed bid including but no limited to, the following.

• Illegibility ofbid.

• Emails over 75 MB may not be received by GPO due to size limitationsfor receiving emails.

• The bidder’s email provider may have different size limitations for sending email; however, bidders 

are advised not to exceed GPO’sstated limit.

• When the email bid is received by GPO, it will remain unopened until the specified bid opening time. 

Government personnel will not validate receipt of the emailed bid prior to bid opening. GPO will use 

the prevailing time (specified as the local time zone) and the exact time that the email is received by 

GPO’s email server asthe official time stamp for bid receipt at the specified location.

Offers: Offers must include the cost of all materials and operations for the total quantity ordered in accordance 

with these specifications. The price for additional quantities must be based on a continuing run, exclusive of all 

basic or preliminary charges and will not be a factor for determination of award. Note: The GPO 910 “BID” 

Form is no longer required; bidders are to fill out, sign initial, as applicable, and return page 8 and 9.

GPO CONTRACT TERMS: Any contract which results from this Invitation for Bid will be subject to the 

applicable provisions, clauses, and supplemental specifications of GPO Contract Terms (GPO Pub. 310.2, effective 

12/1/87, Rev. 01-18) and GPO Contract Terms, Quality Assurance Through Attributes Program (GPO Pub. 310.1,

effectiveMay 1979, (Rev. 09/19).

• GPO Contract Terms (GPO Publication310.2) – https://www.gpo.gov/docs/default-source/formsand-standards-files-for-vendors/contractterms2018.pdf

• GPO QATAP (GPO Publication 310.1) – https://www.gpo.gov/docs/default-source/forms-andstandards-files-for-vendors/qatap-rev-09-19.pdf.

WARRANTY: Contract Clause 15, “Warranty”, of GPO Contract Terms (Publications 310.2, effective December 

1, 1987 (Rev. 01-18) is amended for the solicitation to the effect that the warranty period is EXTENDED from 120 

days to one calendar year from the date the check is tendered as final payment
Jackets 504-830 thru 504-839 Page 2 of 11

PREAWARD SURVEY: In order to determine the responsibility of the prime contractor or any subcontractor, 

the Government reserves the right to conduct an on-site preaward survey at the contractor's/subcontractor's facility 

or to require other evidence of technical, production, managerial, financial, and similar abilities to perform, prior 

to the award of a contract. As part of the financial determination, the contractor in line for award may be required 

to provide one or more of the following financial documents: 

1) Most recent profit and loss statement 

2) Most recent balance sheets

3) Statement of cash flows 

4) Current official bank statement 

5) Current lines of credit (with amounts available) 

6) Letter of commitment from paper supplier(s) 

7) Letter of commitment from any subcontractor 

The documents will be reviewed to validate that adequate financial resources are available to perform the contract 

requirements. Documents submitted will be kept confidential, and used only for the determination of 

responsibility by the Government. Failure to provide the requested information in the time specified by the 

Government may result in the Contracting Officer not having adequate information to reach an affirmative 

determination of responsibility. 

PAYMENT: Submitting invoicesfor payment via the GPO fax gateway (if no samples are required) utilizing the 

GPO barcode coversheet program application is the most efficient method of invoicing. Instruction for using this

method can be found at the followingweb address:

Invoices may also be mailed to: U.S. Government Publishing Office, Office of Financial Management, Attn: 

Comptroller, Stop: FMCE, Washington, DC 20401. 

For more information about the billing process refer to the General Information of the Office of Finance web page 

located at https://www.gpo.gov/how-to-work-with-us/vendors/how-to-get-paid.

NOTE: For billing purposes, each Jacket Number must be BILLED SEPARATELY. The contractor must submit 

the same series of the ordering documents and receipts for each individual invoice/jacket. 

GOVERNMENT TO FURNISH: 10 prior printed folders as reference for stock, layout, construction; 1 CD for 

each folder; Specifications for Kraft-Wrapping, Labeling, Cartons & Pallets (1 sheet); Delivery Instructions –

Navy Forms Material (10); GPO 905 carton label camera copy (10); Warehouse Unit-of-Issue Label (10); GPO 

Delivery Confirmation Fax Sheet.

All expense incidental to picking up and returning materials and furnishing samples must be borne by the 

contractor. See GPO Contract Terms. 

PREFLIGHT: Prior to image processing, the contractor shall perform a basic check (preflight) of the furnished 

media and publishing files to assure correct output of the required reproduction image. Any errors, media damage, 

or data corruption that might interfere with proper file image processing must be reported to mwebb@gpo.gov. 

Any discrepancies of the Government Furnished Materials (GFM) and these specifications, or instances of missing

files, fonts, instructions, etc. are to immediately be brought to the attention of the GPO Philadelphia regionaloffice. 

CONTRACTOR TO FURNISH: All materials and operations, other than those listed under “Government to 

Furnish’, necessary to produce the product(s) in accordance with these specifications.

PRODUCT: File Folders - Letter size expansion type, full cut top tab, two-leaved with one divider, two 

reinforced edges, cloth gussets, requiring printing, die cutting, folding, gluing, affixing four metal fasteners, 

packing and shipping.

QUANTITY : 40,000 each of 10 Folders – Total = 400,000 +/- none

 Plus, Two (2) Departmental Samples of each Jacket (20 total). 
Jackets 504-830 thru 504-839 Page 3 of 11 

TITLE: US Navy Medical Outpatient and Dental Treatment Record Folders.

PROOFS: Contractor to submit one Press Quality PDF soft proof (for content only) using the same Raster Image 

Processor (RIP) that will be used to produce the final printed product. PDF proof will be evaluated for text flow, 

image position, and color breaks. Proof will not be used for color match. 

Contractor must email Lashineda.alsevido@dla.mil, Thomas.hayward@dla.mil and copy mwebb@gpo.gov

Proofs will be held not more than 2 day. 

The contractor must not print prior to receipt of OK to print. 

DESCRIPTION: 

JKT # FORM # STOCK # CONTROL # COLOR QUANTITY

504-830 NAVMED 6150/21 0105-LF-116-8700 SA70041142127 GREEN PMS 360 40,000 

504-831 NAVMED 6150/26 0105-LF-116-9300 SA70041142132 WHITE 40,000 

504-832 NAVMED 6150/24 0105-LF-116-9100 SA70041142130 TAN PMS 465 40,000 

504-833 NAVMED 6150/22 0105-LF-116-8800 SA70041142128 YELLOW PMS 114 40,000 

504-834 NAVMED 6150/25 0105-LF-116-9200 SA70041142131 BLUE PMS 310 40,000 

504-835 NAVMED 6150/27 0105-LF-116-9400 SA70041142133 BROWN PMS 464 40,000 

504-836 NAVMED 6150/30 0105-LF-116-9700 SA70041142136 ORANGE PMS 160 40,000 

504-837 NAVMED 6150/23 0105-LF-116-9000 SA70041142129 GRAY PMS 414 40,000 

504-838 NAVMED 6150/29 0105-LF-116-9600 SA70041142135 RED PMS 184 40,000 

504-839 NAVMED 6150/28 0105-LF-116-9500 SA70041142134 PINK PMS 182 40,000 

TRIM SIZE: Overall flat size: 19-1/2 x 11-3/4” 

 Front Leaf (Page 1 & 2) – 9 x 11-3/4” 

 Inner Leaf (Page 3 & 4) – 9 x 11-1/4” 

 Back Leaf (Page 5 & 6) – 9-1/2 x 11-3/4” 

NOTE: Each item will surprint in black ink on a different Pantone color background, except for Jacket 504-831 

which prints black only. Pantone color backgrounds are in designated areas on folders; folders are not flood 

coated in entirety.

COMPOSITION: Ten (10) different forms: NAVMED 6150/21, 22, 23, 24, 25, 26, 27, 28, 29 and 30. The last 

digit of each number is the Group Number which prints in the upper right corner in the next to last square on the 

top right inside back leaf (when constructed). The type changes from form to form will consist of this Group No. 

and the Form and Stock Nos. on the front outside leaf. 

Three (3) terminal digit scales (0 through 9) printing in three places, on the back leaf only. When folded as one 

reinforced edge, it is on the upper left and prints as part of the top tab. As the second reinforced edge, it is on the 

right side and wraps around to the outside of the back leaf. These scales are 1⁄2 x 1⁄2” squares.

Flat Form: 

Front outside leaf prints landscape with type and rule- no type matter bleeds, pantone color bleeds. 

Front inside leaf prints portrait with type and rule, no bleeds.

Divider front prints portrait with type and rule, no bleeds. 

Divider back prints landscape with type and rule, no bleeds. 

Back inside leaf prints portrait for type, rule and dental illustrations, no bleeds. 

Back outside leaf prints landscape with type and rule- no type matter bleeds, pantone color bleeds.

Constructed Form: 

Back inside leaf has two reinforced edges. When folded, full top tab is reinforced and right edge is reinforced. 

Each edge prints type matter and pantone color. The top edge will view landscaped and right edge will view 

vertical. Reinforced edges do not overlap each other.
Jackets 504-830 thru 504-839 Page 4 of 11

STOCK/PAPER: The specifications of all paper furnished must be in accordance with those listed herein or 

listed for the corresponding JCP Code numbers in the "Government Paper Specification Standards No. 12" dated 

March 2011.

White, High-Finish Folder Stock, basic weight: 150lb. per 500 sheets, 24 x 36”, equal to P20.

PRINTING: All ten folders print in black ink on all leaves. Nine folders overprint black ink on specified 

Pantone colors in designated areas. The designated areas are the same for the nine folders.

Front leaf (page 1): Two, 2” wide bands of the Pantone color, print top and bottom, bleed all sides.

Back leaf (page 5): When folded, a 1” wide band of the Pantone color, is the top and right reinforced edges. 

Back leaf (page 6): When folded, two, 2” wide bands of Pantone color, print across the top and bottom and 1” 

color band on vertical left edge. 

Divider Leaf: Pages 3 and 4, prints black ink only.

ROUND CORNERS: Two, on the 11-3/4” reinforced outside edges of the back leaf.

DIE-CUT: Divider Leaf (pages 3 and 4) has rounded die-cut 1” from bottom and 1⁄2” in width, to create an 

indentation for visibility of all type matter of the right side back leaf reinforced edge.

REINFORCE: Reinforce the 11-3/4” outside *edge of the back leaf with a 1” fold over to the inside, securely 

glued. Reinforce the 9-1/2” bottom *edge of the back leaf with a fold over, 1” wide to the inside, securely glued; 

this reinforcement shall extend along the edge from the fold to (but not overlapping) the outside edge 

reinforcement. In relation to the position of the type, these edges are the top and right edges of the back leaf.

WORKMANSHIP: All workmanship in connection with the folders manufactured under this specification must 

be first class in every respect.

All operations required such as imposition, press makeready, press running and binding must be performed with 

care to insure that (1) the printing on the product delivered will be good, clear, and sharp; (2) the margins as 

indicated in this specification are followed and uniform on all copies; (3) the printed image will be square with the 

trimmed edges; and (4) the folders will be uniformly trimmed, scored, and folded to the size indicated in the 

specification, with the metal fasteners permanently bonded inside the folder, smoothly and straight in the proper 

position.

FASTENERS: Each inside leaf to be equipped with a permanently affixed, prong type, one piece, rust resistant 

metal fastener, similar to Permclip or other fastener of similar design and equal quality and durability which meet 

the following requirements.

a. Quality of metal: Fastener to be made of bonderized and/or baked enamel finished steel, 0.013” plus/minus 

0.001” thickness, Rockwell Hardness F-79 to F-89 and to be of such ductility that it will withstand a 

minimum of 20 ninety-degrees flexings without fracture.

Bend-Test: With the fasteners in the normal flat position, bend the prongs to a vertical position, (an arc of 90 

degree), insert one sheet of punched paper on the prongs and bend the prongs back to the flat position (90 degree 

arc). Continue this cycle of bends a minimum of 20 times not less than 1 minute to complete the 20 cycles.

b. Fastener must be permanently bonded to the inside of folder from the inside with the absence of any external 

projections so as to preclude all possibilities of catch and scratch points. As used in this context, the term 

“permanently bonded” means that the overlay which retains the prong to the folder will remain bonded to the 

folder for the life of folder, approximately 75 years, and that in forcibly removing the overlay the folder itself 

will be torn.

c. Prongs: Width 7/32”; Length 5-3/4” from point to point. Spaced 2-3/4” center to center. Non-woven fiber 

material is 1” width. Metal prongs are 1-1/2” on each side.

d. The fasteners shall be produced with properly maintained dies to ensure that the finished product is free from 

burrs, sharp edges, cracks, flaws and malformations which may cause injury to personnel or damage to filed 
Jackets 504-830 thru 504-839 Page 5 of 11

papers. The fasteners shall be free from oil or grease. The overlay which retains the prongs to the folders 

shall be made of material with tear strength adequate for the severe usage.

e. Permclip type, or equal, fasteners to be securely affixed with permanent type, nonwoven fabric material 

consisting of 20% polyester, 30% nylon, and 50% cellulose, laminated to the folder with an adhesive which 

will permanently bond the fastener, remain flexible for the life of the folder, and not permit fungus or algae 

growth. Prong to be one continuous piece. 

LOCATION OF FASTENERS (4 per folder – all prongs inside); 

1) One at the bottom of the front leaf (page 2), center of fastener 5/8” from bottom edge and 4-1/2” from the 

fold.

2) Two at the top of the divider leaf (pages 3 & 4), center of fastener 5/8” from the top edge and 4-1/2” from the 

fold.

3) One at the top of the back leaf, center of fastener 5/8” from top edge and 4-1/2” from the fold.

CLOTH STRIPS: Tan or light brown pyroxylin impregnated book cloth that conforms to the American National 

Standard to Fabrics for Book Covers, designated ANSI L.29.1 1977 Group O or polyofin book plastic.

Cloth strips are scored and folded at 3/8” intervals (for expansion feature) plus approximately 1⁄2” overlap on all 

leaves of the folder. Total expansion 1-1/2” (3/4” on each side of the inner leaf). Inner cloth strips are 

approximately 1-3/4” wide, outer cloth strip is approximately 2-1/2” wide.

Total expansion: 1-1/2” (3/4” on each side of the inner leaf). 

Leaves are to be flush with the left edge.

See Attachment for folder, fastener, cloth and prong visuals. 

 

PACKING: Pack each Jacket Separately – Do Not Mix Colors. Box 50 folders per carton. Total of 800 Boxes 

for each Jacket-Do not intermix products in cartons or pallets. Warehouse Unit of Issue Label & GPO 905 Yellow 

Labels required on each carton of 50. It may be placed on the ends of the packages, if possible, or on the face of 

each package, centered. Reproduce Unit of Issue labels for each package. Camera-ready label art is provided to 

produce this label. Reproduce at approximately 3-1/4 X 5-1/2 inches, if possible. For smaller packages - this label 

art may be reduced in size to fit the package, as long as the type remains legible. Print on 50 Lb. White Offset 

Book or better or 110 Lb. White Index. Warehouse Unit of Issue labels must include Title, Stock Number, Form 

Number, Control Number, and Quantity. Labeling and Marking Specifications must be followed. 

Pack in shipping containers. Each shipping container must not exceed 40 lbs. when fully packed. GPO form 905 

(L&M Specs.) are required on each carton and must be reproduced on YELLOW stock (20 # writing or equal). 

Carton dimensions (do not exceed): Height: 11 to 12-1/2 inches; Length: 11 to 11-1/2 inches; Width: 17-1/2 to 18 

inches. Use only new corrugated solid fiberboard containers with minimum bursting strength of 275 p.s.i. Single 

or double-wall containers are authorized for use. Triple-walled shipping containers are NOT authorized and must 

not be used. NOTE: Uniform cartonization is required. Cartons are to contain equal amounts of Units of Issue in 

each shipping carton. There may be 1 carton with an odd amount, which will be placed on top of the first skid 

with its lesser quantity clearly marked. Failure to properly cartonize unit of issue boxes and shipping cartons will 

result in refusal at the warehouse, and return to the Contractor for proper packing and reshipment at the 

Contractor expense.

PALLETS: Pallets are required for all destinations receiving 10 or more shipping containers. NOTE: Failure to 

properly palletize may be cause for either repalletizing or refusal to accept, requiring the contractor to pick up, 

repalletize and re-deliver the job at their expense. Pallets must meet the following requirements to be used with 

the Standard Warehouse Operating System in the Army distribution warehouse. 

Packages shall be clearly marked with specific contents and quantities and shall weigh no more than 50 lbs. 

individually. Blue Label boxes (if any), should be clearly marked and placed near the top of the pallet. Boxes 

should be of sufficient strength to support stacking on a pallet. Palletized shipments shall be shrink wrapped and 

secure not to exceed 56” in height with pallets suitable for movement with material handling equipment. 
Jackets 504-830 thru 504-839 Page 6 of 11

JFOL requires advance notification of pending shipments once scheduled with carrier for delivery to include 

tracking or PRO #’s forwarded to the following individuals:

Shaun Sullivan – shaun.sullivan@dla.mil – (405) 226-3068 

Lindsay Brock – lindsay.brock@dla.mil – (405) 203-8806

SCHEDULE: Adherence to this schedule must be maintained. See “Notice of Compliance with Schedules”, in 

GPO Pub. 310.2 Rev. 1-18. Purchase Order and furnished material will be electronically available to provide to 

the contractor by June 15, 2021. 

Unscheduled material such as shipping documents, receipts or instructions, delivery lists, labels, etc., will be 

furnished with the order or shortly thereafter. In the event such information is not received in due time, the 

contractor will not be relieved of any responsibility in meeting the shipping schedule because of failure to request 

such information. 

RECEIPT FOR DELIVERY: As applicable, the contractor must furnish their own receipts for deliveries. These 

receipts must include the GPO jacket number; total quantity delivered number of cartons, and quantity per carton; 

date delivery made; and signature of the Government agent accepting delivery. The original copies of these 

receipts must accompany the contractor’s invoice for payment. 

Ay Order Delivery/Tracking Report is required for all deliveries. Contractor to update report with each shipment 

and each confirmed delivery and email to: Lashineda.alsevido@dla.mil, Thomas.hayway@dla.mil and 

mwebb@gpo.gov. 

DISTRIBUTION – Deliver F.O.B destination. Ship all destinations by traceable means. All expenses incidental 

to picking up and returning materials and samples must be borne by the contractor

Deliver Partial of 10,000 (1,000 each of the 10 Jackets) on/or before July 12, 2021:

Deliver Balance of 390,000 (39,000 each of the 10 Jackets) on/or before September 30, 2021:

Deliveries shall be made to the following address during the day and times listed below:

DLA-J67F JFOL

3420 D. Avenue, Building 1, Door 5

Tinker AFB, OK 73145

Attn: Shaun Sullivan

(405) 855-3039

Monday – Friday – 7:00 AM – 3:00 PM 

Advance Notice is Required for Delivery.

Instructions are subject to change prior to each contract award and if changes occur JFOL will contact appropriate 

personnel once specified. 

Return GFM, CD & 2 Samples of each Jacket to: 

DLA Strategic Data Operations 

Attn: Lashineda Alsevido -- 504-830 through 504-839

700 Robbins Avenue, Bldg. 4-D

Philadelphia, PA 19111 
Jackets 504-830 thru 504-839 Page 7 of 11

QUALITY ASSURANCE LEVELS AND STANDARDS: The following levels and standards shall apply to 

these specifications:

Product Quality Levels: 

(a) Printing Attributes -- Level III

(b) Finishing Attributes – Level. III

Inspection Levels (from ANSI/ASQC Z1.4):

(a) Non-destructive Tests -- General Inspection Level I.

(b) Destructive Tests -- Special Inspection Level S-2.

Specified Standards: The specified standards for the attributes requiring them shall be:

Attribute Specified Standard

P-7. Type Quality and Uniformity Government furnished Sample/Digital Media/Approve Proofs

P-9. Solid or Screen Tints Color Match Pantone Matching System/ Approve Proofs

QUALITY ASSURANCE RANDOM COPIES: The contractor is required to submit quality assurance random 

copies to test for compliance against specifications. The contractor must divide the entire order into 32 equal 

sublots for each Jacket and select a copy from a different general area of each sublot. The contractor will be 

required to execute a statement furnished by GPO certifying that copies were selected as directed. A copy of the 

purchase order/specifications must be included.

Business Reply Mail labels will be furnished for mailing the quality assurance random copies (***NOTE: to be 

mailed to WASHINGTON, DC). The copies are to be mailed at the same time as the first scheduled shipment. 

A U.S. Postal Service approved Certificate of Mailing, identified by Jacket and Purchase Order number must be 

furnished with billing.

***Immediately upon completion and shipping of the above materials, return 2 samples of each Jacket, and all 

GFM’s. Itemized receipts and copies of "Packing Slips", including "Proof of Delivery" receipts with signatures 

for the above shipment email to lashineda.alselvido@dla.mil. Contractor’s invoice for this order will not be paid 

unless DLA Document Services has verified receipt of Government Furnished Material.
Jackets 504-830 thru 504-839 Page 8 of 11

BID OFFER

SHIPMENT(S): Shipments will be made from: City __________________________, State ________________

504-830: Bid Price $___________________ Additional Rate, per 1,000 $___________ 

504-831: Bid Price $___________________ Additional Rate, per 1,000 $___________ 

504-832: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-833: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-834: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-835: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-836: Bid Price $___________________ Additional Rate, per 1,000 $___________ 

504-837: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-838: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

504-839: Bid Price $___________________ Additional Rate, per 1,000 $___________

 

 

 Total for all 10 Jackets $ ________________________________ 

 Initials: _______________

DISCOUNTS: Discounts are offered for payment as follows: __________ Percent, _________calendar days. 

See Article 12 “Discounts” of Solicitation Provisions in GPO Contract Terms (Publication 310.2).

BID ACCEPTANCE PERIOD: In compliance with the above, the undersigned agree, if this bid is accepted 

within____________ calendar days (60 calendar days unless a different period is inserted by the bidder) from the 

date for receipt of bids, to furnish the specified items at the price set opposite each item, delivered at the 

designated points(s), in exact accordance with specifications.

NOTE: Failure to provide a 60-day bid acceptance period may result in expiration of the bid prior to award.

AMENDMENT(S): Bidder hereby acknowledges amendment(s) number(ed) ____________________________

BIDDER’S NAME AND SIGNATURE: Unless specific written exception is taken, the bidder, by signing and 

submitting a bid, agrees with and accepts responsibility for all certifications and representations as required by the 

solicitation and GPO Contract Terms – Publication 310.2. When responding by email, fill When responding by fax 

or mail, fill out and return one completed copy of all applicable pages that include the Jacket Number, Bid Price, 

Additional Rate, Discounts, Amendments, Bid Acceptance Period, and Bidder’s Name and Signature, including 

signing where indicated. Valid electronic signatures will be accepted in accordance with the Uniform Electronic 

Transactions Act, § 2. Electronic signatures must be verifiable of the person authorized by the company to sign bids.
Jackets 504-830 thru 504-839 Page 9 of 11

 Failure to sign the signature block below may result in the bid being declared non-responsive.

 ____________________________________________ _________________________________

(CompanyName) (GPO Contractor’sCode)

(Street Address, City, State and Zip Code)

(Printed Nameand Title) (Telephonenumber)

(Signature) (Date)

(E-Mail) (FacsimileNumber)

**************************************************************************************** 

THIS SECTION FOR GPO USE ONLY

Certified by: Date: ContractingOfficer: Date: (Initials)
Jackets 504-830 thru 504-839 Page 10 of 11
Jackets 504-830 thru 504-839 Page 11 of 11