Jacket: 747-680S

Title:

Agency: Veterans Administration

Bid Opening: September 9, 2020 at 1:00 PM

Bid Terms Discounted Total

$152,916.67 2.0% 21 days $149,858.34

$189,252.00 2.0% 20 days $185,466.96

$208,057.00 2.0% 20 days $203,895.86

$225,788.06 1.0% 20 days $223,530.18

$232,232.00 2.0% 20 days $227,587.36

$265,555.00 5.0% 20 days $252,277.25

dlp 9/9/20 /

2020 Federal Benefits for Veterans, Dependents and Survivors

Alcom Printing

Contractor Name

NPC Inc.

Gray Graphics Corp

Advantage Mailing LLC

Monarch Litho, Inc.

Las Vegas Color Graphics
Specifications by dlp Jacket 747680/681/685/692/693/694/695/696/697/698/699/700

Reviewed by EBR/JB Veterans Affairs 0-00219 (see below)

Page 1 of 10 

BID OPENING: Bids shall be opened at 1:00 p.m., prevailing Central Time (Dallas, TX), on September 9, 2020, 

at the Government Publishing Office, Dallas, TX. Due to the COVID-19 pandemic, this will NOT be a public bid 

opening. 

For information of a technical nature, contact Denise Przybylowicz at dprzybylowicz@gpo.gov or 214-767-0451, x7.

SPECIFICATIONS

U.S. Government Publishing Office (GPO)

Dallas Regional Office

1100 Commerce St., Room 731

Dallas, TX 75242

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 Publication 310.2, 

effective December 1, 1987 (Rev. 01-18)) and GPO Contract Terms, Quality Assurance Through Attributes 

Program for Printing and Binding (GPO Publication 310.1, effective May 1979 (Rev. 09-19)). 

PRODUCT: This specification is for proofing, printing, binding, packing, and shipping of saddle-stitched

pamphlets on the date specified.

TITLE: Federal Benefits for Veterans, Dependents, & Survivors, 2020

QUALITY LEVEL: III Quality Assurance Through Attributes (GPO Pub 310.1, effective May 1979 (Rev. 09-19) 

applies.

QUANTITY: 755,144 total copies

Jacket 747-680, req 0-00219: 609 copies

Jacket 747-681, req 0-00220: 250 copies

Jacket 747-685, req 0-01132: 5,000 copies

Jacket 747-692, req 0-00221: 65 copies

Jacket 747-693, req 0-00222: 20 copies

Jacket 747-694, req 0-00223: 606,630 copies

Jacket 747-695, req 0-00224: 100 copies

Jacket 747-696, req 0-00225: 100,000 copies

Jacket 747-697, req 0-00228: 39,800 copies

Jacket 747-698, req 0-00229: 60 copies

Jacket 747-699, req 0-00231: 2,500 copies

Jacket 747-700, req 0-00232: 110 copies

TRIM SIZE: 5-1/4 x 8-1/4”

PAGES: 76 pages plus separate cover

DESCRIPTION: Covers 1 and 4 print head to head, type, line matter, illustrations, tints/solids with reversing in black 

ink only. Cover 1 bleeds uncommon. Covers 2 and 3 are blank. Cover 4 contains a return address and is set up as a 

mailing page. Contractor will print a bar code on Cover 4, furnished as a separate file. 
Page 2 of 11 Jacket 747-680 Strapped

Text pages print face & back, head to head, type and line matter in black ink, no bleeds. Contractor to add a blank page 

after Roman numeral V and after folio 69.

Score and fold cover parallel to the grain.

Contractor to send via CD or email a copy of final printed file to GPO (see distribution).

For Sale Line instructions:

The 13 digit ISBN Number should be placed under the "For Sale By ... " line, at the bottom of the back

side of the first printed page in the book. Government will furnish the "For Sale By ... "

copy via e-mail at time of contract award.

ISBN Barcode instructions:

The ISBN barcode must be printed in black ink at the bottom-right corner or bottom-center of Cover

4. The ISBN number must be printed in Human-Readable interpretation and bar coded using 3 of 9

(code 39) Bar Code System, non-contact reading in accordance with IS0-2108:2005.

BINDING: Saddle stitch in 2 places on the 8-1/4” side. Trim 3 sides.

GOVERNMENT TO FURNISH: 

1 PDF file containing covers and text pages, 1 PDF for bar code, a VA packing slip and VA carton label, Excel 

spreadsheets for distribution addresses, and Purchase Order.

Electronic Media: Files supplied - Adobe PDFs created using Adobe InDesign CC, all fonts are embedded, all bleeds 

are included, and graphics are linked. 

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 your contract administrator.

The contractor shall create/alter any necessary trapping, set proper screen angles and screen frequency, and define file 

output selection for the imaging device being utilized. Furnished files must be imaged as necessary to meet the 

assigned quality level.

ADDITIONAL INFORMATION:

- Contractor must have the ability to edit PDF files (when furnished by the Government). 

- Contractor is not to request that electronic files provided be converted to a different format. If contractor wishes to 

convert files to a different format, the final output must be of the same or higher quality and at no additional cost to the 

Government.

- The contractor is cautioned that furnished fonts are the property of the Government and/or its originator. All 

furnished fonts are to be eliminated from the contractor's archive immediately after completion of the contract.

- Identification markings such as register marks, commercial identification marks of any kind, etc., except form number 

and revision date, carried in the electronic files, must not print on the finished product.

- 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 your contract administrator.

- The contractor shall create/alter any necessary trapping, set proper screen angles and screen frequency, and define file 

output selection for the imaging device being utilized. Furnished files must be imaged as necessary to meet the assigned 

quality level.

- When PostScript Files are not furnished - prior to making revisions, the contractor shall copy the furnished files and 

make all changes to the copy.

- Upon completion of this order, the contractor must furnish final production native application files (digital 

deliverable) and one "press quality" PDF file with the furnished media. Storage media must be MAC/PC compatible. 
Page 3 of 11 Jacket 747-680 Strapped

The digital deliverables must be an exact representation of the final product and shall be returned on the same type of 

storage media as was originally furnished. The Government will not accept, as digital deliverables, PostScript files, 

Adobe Acrobat Portable Document Format (PDF) files, or any proprietary file formats other than those supplied, unless 

specified by the Government.

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.

COVER: JCP L20, White Vellum Finish Cover, Basis Weight 65 lb., 20 by 26 inches, 500 sheets.

TEXT: JCP A60, White Offset Book, Basis Weight: 50 lb., 25 by 38 inches, 500 sheets.

The requirement for postconsumer fiber (as specified in the Government Paper Specification Standards No. 12) for this 

contract is waived. However, the addition of post-consumer fiber is encouraged provided that the requirements of this 

Standard are met. All other attributes remain the same.

BIDDERS, PLEASE NOTE: GPO has issued a new Government Paper Specification Standards, No. 13, dated 

September 2019. Prospective bidders should carefully read this publication as the applicable standards within become 

an integral part of this contract. The document is posted at https://www.gpo.gov/how-to-work-withus/vendors/formsand-standards along with a list of major revisions. 

INK: Black.

If lithographic ink is used in the performance of this contract, the ink shall contain not less than the following 

percentages of vegetable oil: (a) news ink, 40 percent; (b) sheet-fed and forms ink, 20 percent; and (c) heat-set ink, 10 

percent. High quality color process printing on high-speed heat-set presses is excepted when slow drying time 

significantly increases production costs.

MARGINS: Bleeds on Cover 1.

PROOFS: Contractor to email an Adobe Acrobat PDF proof to Customer on or before September 11, 2020.

Email proof to penny.woods2@va.gov, rick.gordon@va.gov, and dprzybylowicz@gpo.gov.

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 and image position. 

Contractor must call 214-767-0451, x7 to confirm receipt of proof, which will be evaluated within ONE (1) work day 

(s) upon receipt. 

Approval or conditional approval shall not relieve the contractor from complying with the specifications and all other 

terms and conditions of the contract. A conditional approval shall state any further action required by the contractor. A 

notice of disapproval shall state the reasons therefore.

NOTE: The day the email is sent is not the first workday.

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.

BINDING: Saddle stitch in two places on the left 8-1/4” side.

PALLETIZING: All motor freight shipments require pallets. Palletize in accordance with GPO Pub. 310.2, Contract 

Terms, revised January 2018.
Page 4 of 11 Jacket 747-680 Strapped

PACKING/LABELING: Standard pack is 100 pamphlets per carton as destination quantities dictate. Pack suitably in 

cartons using supplied VA packing slip. Shipping containers must not exceed 30 lbs. when fully packed. Use only new 

corrugated or solid fiberboard containers with minimum bursting strength of 275 psi. 

Must mark all VA cartons with VA labels as noted from file provided. Each label must accurately state what is included 

in each package/carton. Contractor may duplicate common information when printing labels and then customize for 

each specific carton.

Noncompliance with the packing and marking instruction will be cause for the Government to take corrective action in 

accordance with GPO Pub. 310.2, Contract Terms, revised January 2018.

SCHEDULE:

Award will be made and purchase order issued by September 10, 2020.

PDF Proofs will be due to deliver to agency and GPO on or before September 11, 2020.

Completion of entire project on or before October 2, 2020, as directed by “Distribution”.

DISTRIBUTION: Contractor must notify the ordering agency on the same day that the product ships/delivers via email sent to penny.woods2@va.gov, rick.gordon@va.gov, and dprzybylowicz@gpo.gov. The subject line of this 

message shall be "Distribution Notice for Jacket 747-680S/REQ: 20-00219, et al". The notice must provide all 

applicable tracking numbers, shipping method, and Title. Contractor must be able to provide copies of all delivery, 

mailing, and shipping receipts upon agency request.

All expenses incidental to picking up and returning materials, and furnishing samples must be borne by the contractor. 

Also, refer to Articles 5 and 6, Supplemental Specifications, GPO Contract Terms, Publication 310.2, revised January 

2018.

F.O.B. DESTINATION AND F.O.B. CONTRACTOR’S CITY:

MAILING REQUIREMENTS FOR ALL F.O.B CONTRACTOR’S CITY (JACKETS 747-694 & 747-697): All 

mailing shall be made at the Standard Pre-Sort Rate utilizing contractor reimbursable postage. 

The contractor must pass entire address file against a USPS Code Accuracy Support System (CASS) certified software 

address hygiene program. Contractor's software must also be Presort Accuracy Validation and Evaluation (PAVE) 

certified. Contractor is responsible to meeting USPS move requirements by passing file against the National Change of 

Address Link (NCOA Link) file using a USPS Full Service Provider. 

The contractor’s mail processing software must correct addresses with the most current information from USPS 

databases. To provide the highest level of readability for the post office, the software must standardize abbreviations 

and fonts and add ZIP+4 codes and PostNet barcodes. Contractor's software must be CASS certified through NCOA at 

least three times per year. The contractor must also utilize the Fast Forward program of the USPS to ensure the 

maximum possibility of all addressees receiving the letter sent to them. 

All possible methods to determine if the mailing addresses are accurate must be utilized. Any addresses that are 

determined to be undeliverable must be pulled from the file. A report of address corrections and undeliverables must be 

completed and sent to penny.woods2@va.gov, rick.gordon, brian.mano@va.gov.

All copies mailed must conform to the appropriate regulations in the U.S. Postal Service manuals for "Domestic Mail" 

or "International Mail", as applicable.

Certificate of Conformance: When using Permit Imprint Mail the contractor must complete GPO Form 712 -

Certificate of Conformance (Rev. 2-91), supplied by GPO and the appropriate mailing statement or statements, supplied 

by USPS.
Page 5 of 11 Jacket 747-680 Strapped

SHIP FOB CONTRACTOR’S CITY:

Ship the following on or before October 2, 2020:

Jacket 747-694

90 continental US destinations and (2) Overseas destinations per distribution list

------------------------------606,630 copies per distribution list,

Jacket 747-697

83 continental US destinations per distribution list

------------------------------39,800 copies

DELIVER THE FOLLOWING FOB DESTINATION:

CRITICAL - Deliver on or before September 18, 2020

Jacket 747-699

US Department of Veterans Affairs

VA Congressional Liaison Service

US House of Representatives

ATTN: Thomas Garloch. 202-891-9579

Rayburn House Office Building, Room 2026

Washington, DC 20515

------------------------------2,500 copies

Deliver the following on or before September 22, 2020

Jacket 747-680

US Department of Veterans Affairs

ATTN: Jeanette Mendy, 202-461-6544

810 Vermont Ave., NW, 9th Floor

Washington, DC 20420

------------------------------400 copies

Jacket 747-681

US Department of Veterans Affairs

ATTN: Anita Major, 202-461-7440

810 Vermont Ave. NW (Room 905)

Washington, DC 20420

-----------------------------250 copies

Jacket 747-692 (1 of 2 shipments) 

US Department of Veterans Affairs

ATTN: Ama Hunter, 202-461-4882

810 Vermont Ave., NW, (Room 1016) 

Washington, DC 20420

------------------------------45 copies

Jacket 747-692 (2 of 2 shipments)

US Department of Veterans Affairs

ATTN: Michael Visconage, 202-384-5360

810 Vermont Ave., NW, (Room 518)

Washington, DC 20420

------------------------------20 copies
Page 6 of 11 Jacket 747-680 Strapped

Deliver on or before September 22, 2020 (continued):

Jacket 747-693

US Department of Veterans Affairs

ATTN: Sue Hamlin White, 202-632-5100

Board of Veterans’ Appeals, Room 5E.105C

425 I Street, NW

Washington, DC 20001

------------------------------20 copies

Jacket 747-695

US Department of Veterans Affairs 

ATTN: Thaddeus Cooks for Jahmarreh Smoot, 202-461-5620 and 202-912-0918

810 Vermont Ave. NW (Room B50)

Washington, DC 20420

-----------------------------100 copies

Jacket 747-698

US Department of Veterans Affairs

ATTN: Delores Tyms-Williams, 202-461-5141

810 Vermont Ave. NW

Washington, DC 20420

-----------------------------60 copies

Jacket 747-700 (1 of 2 shipments)

US Department of Veterans Affairs

ATTN: Steven Carney, 202-461-5800

810 Vermont Ave., NW, (Suite 300)

Washington, DC 20420

------------------------------80 copies

Jacket 747-700 (2 of 2 shipments)

US Department of Veterans Affairs

ATTN: Steven Carney, 202-461-5800

1717 H St NW, (539J)

Washington, DC 20420

------------------------------30 copies

Deliver on or before September 30, 2020:

Jacket 747-696 

US Department of Veterans Affairs

SDC/OPS, Bldg. 37, Door 14

ATTN: John Burke, 708-786-7758

1

st Avenue, One Block North of 22nd St.

Hines, IL 60141

-------------------------------100,000 copies

NOTE: Must be delivered on pallets. Warehouse hours are between 7:00 – 14:00 Central Standard Time.
Page 7 of 11 Jacket 747-680 Strapped

Deliver on or before October 2, 2020:

Jacket 747-685

Documents Warehouse

Receiving Branch, STOP SSWR

US Government Publishing Office

8660 Cherry Lane

Laurel, MD 20707-4950

-----------5,000 copies (Mark ISBN 978-0-16-095354-5 AND Stock Number 051-000-00279-2 on all cartons)

Jacket 747-680

BAC (By-Law) 1525-01

Library of Congress

US Serials and Government Documents Section

U.S. Anglo Division

101 Independence Ave., SE, Stop 4276

Washington, DC 20540-4276

Marked: Depository File Copies

-------------------------------15 copies

Jacket 747-680

BAC (FDLP) 1520-01 Marked: Depository item: 0988

US Government Publishing Office

Federal Depository Library Program (FDLP)

Document Warehouse

8660 Cherry Lane

Laurel, MD 20707-4986

--------------------------------191 copies

Jacket 747-680

U.S. Government Publishing Office

1100 Commerce Street, Suite 731

Dallas, TX 75242

-----------1 copy as inspection sample. M/F Sample/747-680/dlp

Jacket 747-680

US Department of VeteranAffairs

ATTN: Penny Woods

3525 Ferry Landing Road

Dunkirk, MD 20754

----------2 copies as inspection samples.

Send a copy of the final print file on a CD to:

U.S. Government Publishing Office

710 N. Capitol ST NW

Tiffany Merrick 5th floor Room A-506

Washington, DC 20401

OR send a PDF file to tmerrick@gpo.gov

QUALITY ASSURANCE THROUGH ATTRIBUTES: The bidder agrees that any contract resulting from bidder’s 

offer under these specifications shall be subject to the terms and conditions of GPO Pub. 310.1 “Quality Assurance 

Through Attributes – Contract Terms” in effect on the date of issuance of the invitation for bid. GPO Pub 310.1 is 
Page 8 of 11 Jacket 747-680 Strapped

available without charge from: U.S. Government Publishing Office, Dallas Regional Office, 1100 Commerce St., Room 

731, Dallas, TX 75242.

LEVELS AND STANDARDS: The following levels and standards shall apply to these specifications:

Product Quality Levels:

 (a) Printing (page related) Attributes – Level III

 (b) Finishing (item related) 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 Specified Standard 

P-7 Type Quality and Uniformity File Output

 

NOTE: Prior to award, contractor may be required to provide information related to specific equipment that will be 

used for production.

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

these specifications. In addition, a price must be submitted for each additional one hundred pamphlets. The price of 

the additional quantities must be based on a continuing run, exclusive of all basic or preliminary charges (but will 

include shipping), and will NOT be a factor for determination of award.

BID SUBMISSION: Due to the COVID-19 pandemic, the physical office will NOT be open. Based on this, bidders 

must submit email bids to bidsdallas@gpo.gov for this solicitation. No other method of bid submission will be 

accepted at this time. The Jacket number, bid opening date, and company name must be specified in the subject line of 

the emailed bid submission. Bids received after 1:00 p.m. on the bid opening date specified above will not be 

considered for award.

NOTE: Bidders are to fill out, sign/initial, and return “CONTRACTOR’S BID” section (pages 10 and 11).

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 not limited to, the following –

1. Illegibility of bid. 

2. Emails over 75 MB may not be received by GPO due to size limitations for receiving emails. 

3. The bidder’s email provider may have different size limitations for sending email; however, bidders are advised not 

to exceed GPO’s stated limit. 

4. 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 as the official time stamp for 

bid receipt at the specified location.

DOING BUSINESS WITH GPO CUSTOMER SERVICES DURING THE CORONAVIRUS PANDEMIC:

Contractors should continue performance on contracts. Contractors must continue to fully comply with the terms and 

conditions of these contracts. Deliveries, proof approvals, and press sheet inspections for agencies may be impacted. It 

is requested that contractors contact a Government employee at the delivery location to confirm their availability to 

receive prior to shipping. 

Schedules and other adjustments will be made in accordance with GPO Contract Terms. Caution should be used to 

safeguard all products should any delivery delays be imposed by the Government. 
Page 9 of 11 Jacket 747-680 Strapped

As a reminder, contractors must furnish contract compliance information required in accordance with GPO Contract 

Terms, Contract Clause 12: Notice of Compliance With Schedules. 

Contractors should immediately contact your GPO contract administrator(s) and/or contracting officer(s) to identify 

impacted orders if any delay is anticipated, including temporarily closure of a production facility or the planned 

suspension of any services. If you have any questions on a particular contract, please contact the Customer Services 

contract administrator and/or contracting officer for your contract (best method of communicating with them is via 

email). Office team email addresses can be found at https://www.gpo.gov/how-to-work-with-us/agency/servicesforagencies/procurement-services-team.

PRE-AWARD 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 sheet 

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 invoices for payment via the GPO fax gateway (if no samples are required) utilizing the GPO 

barcode coversheet program application is the most efficient method of receiving payment. Instruction for using this 

method can be found at the following web address:

http://winapps.access.gpo.gov/fms/vouchers/barcode/instructions.html. 

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/agency/billing-and-payment.
Page 10 of 11 Jacket 747-680 Strapped

CONTRACTOR: ____________________________ 

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

The city(ies) indicated above will be used for evaluation of transportation charges when shipment f.o.b. contractor’s 

city is specified. If no shipping point is indicated above, it will be deemed that the bidder has selected the city and state 

shown below in the address block, and the bid will be evaluated and the contract awarded on that basis. If shipment is 

not made from evaluation point, the contractor will be responsible for any additional shipping costs incurred. 

Total Combined Bid Amount of all Jackets: ____________________________ 

Additional rate per 100 pamphlets: _______________ 

Jacket: 747-680 Bid Price $___________________

Jacket: 747-681 Bid Price $___________________

Jacket: 747-685 Bid Price $___________________

Jacket: 747-692 Bid Price $___________________

Jacket: 747-693 Bid Price $___________________

Jacket: 747-694 Bid Price $___________________

Jacket: 747-695 Bid Price $___________________

Jacket: 747-696 Bid Price $___________________

Jacket: 747-697 Bid Price $___________________

Jacket: 747-698 Bid Price $___________________

Jacket: 747-699 Bid Price $___________________

Jacket: 747-700 Bid Price $___________________

------------- ______

(Initials)

(COMPLETE AND SUBMIT THIS PAGE WITH YOUR BID)
Page 11 of 11 Jacket 747-680 Strapped

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 fax or mail, fill out and return one copy 

of pages 8, 9 and 10, initialing/signing where indicated.

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

Bidder ___________________________________________________________________________________

(Contractor Name) (GPO Contractor’s Code)

___________________________________________________________________________________________

(Street Address)

___________________________________________________________________________________________

(City – State – Zip Code)

By_________________________________________________________________________________________

(Printed Name, Signature, and Title of Person Authorized to Sign this Bid) (Date)

___________________________________________________________________________________________

(Person to be Contacted) (Telephone Number) (Email)

(COMPLETE AND SUBMIT THIS PAGE WITH YOUR BID)

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

THIS SECTION FOR GPO USE ONLY

Certified by:__________ Date:___________ Contracting Officer:__________ Date:___________

(Initials) (Initials)

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