Jacket: 771‐343

Title: Form 9844 ‐ ITIN/Foreign Certification Program InkJet Roll Paper

Agency: Treasury/IRS

Bid Opening: July 19, 2023 at 11:00AM

Bid Terms Discounted Total

$250,106.00 2.0% 20 days $245,103.88

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KDM Products

Contractor Name
Scoti Cox 7/20/2023 /
Jacket 771-343 Page 1 of 10 

Specifications by SC Treasury/IRS 3-05669 

Reviewed by JY 

U.S. GOVERNMENT PUBLISHING OFFICE 

Southwest Region 

General Terms, Conditions and Specifications 

For the procurement of 

ITIN/Foreign Certification Program InkJet Roll Paper (Form 9844) 

As requisitioned from the U.S. Government Publishing Office (GPO) by the 

Department of the Treasury/Internal Revenue Service 

BID OPENING: Bids shall be opened at 11:00 a.m., prevailing Pacific Standard Time (PST), on July 19, 2023 at the 

U.S. Government Publishing Office, Southwest Region. 

BID SUBMISSION: Bidders MUST email bids to bidssanfran@gpo.gov for this solicitation. No other method of bid 

submission will be accepted at this time. The jacket number and bid opening date must be specified in the subject line 

of the emailed bid submission. Bids received after 11:00am on the bid opening date specified above will not be 

considered for award. This will not be a public bid opening. 

Bidders are to fill out, sign/initial, as applicable, Page 9 “SCHEDULE OF PRICES”. 

BIDDER 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 out and return one 

completed copy of all applicable pages (pg. 7) 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. 

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 75MB may 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. 

For information regarding the solicitation requirements prior to award, please email scox@gpo.gov. 
Jacket 771-343 Page 2 of 10 

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)). 

GPO Contract Terms (GPO Publication 310.2) – https://www.gpo.gov/docs/default-source/forms-and-standards-filesfor-vendors/contractterms2018.pdf. 

GPO QATAP (GPO Publication 310.1) – https://www.gpo.gov/docs/default-source/forms-and-standards-files-forvendors/qatap-rev-09-19.pdf. 

PREAWARD SURVEY: In order to determine the responsibility of the prime contractor, the Government reserves 

the right to conduct an on-site pre-award 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) 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. 

NOTE: Prior to award the apparent low vendor must be able to show ability to produce the product in question and 

may be asked to supply samples of similar items. 

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

specifications: 

Product Quality Levels: 

(a) Printing Attributes - Quality Level 3 

(b) Finishing Attributes - Quality Level 3 

Inspection Levels from ANSI/ASQC Z1.4 (MIL-STD 105): 

(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 Ok Pre-Production Samples 

P-8. Halftone Match (Single and Double Impression) Ok Pre-Production Samples 

P-9. Solid and Screen Tint Color Match Ok Pre-Production Samples 

P-10. Process Color Match Ok Pre-Production Samples 

PREDOMINANT FUNCTION: The predominant function for this procurement is the printing of the paper 

rolls/forms. 

SUBCONTRACTING: Subcontracting is NOT authorized. 
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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 invoicing. 

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/vendors/how-to-get-paid 

Vendors are expected to submit invoices within 30 days of job shipping/delivery. 

SECURITY CLAUSE: 

Safeguards: Contractor is required to implement security measures to ensure security handling of all materials and 

prevent unauthorized access. All waste materials, printing plates and overages are to be accounted for and destroyed 

beyond recognition. All shipping or mailing of material is to be accomplished by traceable means. No quantity 

variations are allowed. 

Security Controls: To ensure the contractor’s facility can provide the necessary controls to safeguard security material, 

a tour of the facility may be conducted by IRS Security personnel. The review of the facility may include, by not 

limited to the following: 

1. Physical security controls, 

2. Protection of data recorded on magnetic media, 

3. Protection of date recorded on hard copy media, 

4. Identification and authentication controls, 

5. System accountability controls, 

6. Protection of residual data, 

7. Back up procedures, 

8. Fire detention and annunciation, 

9. Contingency plans, and 

10. Personnel security. 

Contractor will be required to make reasonable changes to their facility and/or procedures to properly safeguard 

security material if necessary. If requirements are not met, security material can be procured from other sources. GPO 

must be notified of any changes. 

WARNING: Proper control and handling must be maintained at all times to prevent any information or materials 

required to produce the product ordered under these specifications from falling into unauthorized hands. Unless 

otherwise indicated herein, all extra copies, materials, waste, etc., must be destroyed. 

TITLE: ITIN/Foreign Certification Program InkJet Roll Paper

QUANTITY: 100 ITIN Paper Rolls (80,000 forms per roll; 8,000,000 forms) 

PAPER ROLL SIZE: 50” diameter (each roll) 

TRIM SIZE: 8-1/2 x 11” (Sheet Size) 

FORM NUMBER: IRS Form 9844 (Rev. 5-2020) 
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PRODUCT DESCRIPTION: 

FORM: Form is printed two up on continuous rolls of special security paper, one side only. IRS logo MUST come off 

of the roll bottom of the seal first. The back side of form prints black timing marks. Rolls must be compatible for use 

on IBM InfoPrint 5000 Inkjet Printers. Dimensions are 50" in diameter (+/- 1/32") by 17" wide, with a 6" diameter 

core. 

One roll of paper is equal to at least 80,000 sheets, 8-1/2 x 11". 

Splices are acceptable if clean edged. No single roll shall have more than one splice. Tape used to secure splices must 

meet requirements for use on the IBM InfoPrint 5000 Inkjet Printer and withstand the extremities of warehouse 

storage conditions. Rolls must be marked to indicate the exact location of the splice. 

Contractors to familiarize themselves with IBM InfoPrint 5000 Inkjet Printers. 

PRODUCTION NOTE: The contractor MUST deliver at least 80,000 forms per roll. No deviations in quantities are 

allowed, per roll. All rolls with less than 80,000 forms must be picked up by the contractor to be corrected and 

returned to IRS, at contractor's expense. 

PRINTING: Form prints in Green PMS 343, with a 7% screen background to 7-7/8 x 11" (has a 5/8 blank strip 

running down the left edge), a 25% screen tint of the Treasury Department logo reversing out and timing marks in 

black ink. There should be a 3/8" white gap between the continuous forms. The logo is to be centered on the 8-1/2 x 

11" form. Back side prints timing marks in black ink. 

The product identifier at the bottom of the roll. No pin feed is required. 

Form 9844 (Rev. 5-2020) Cat. No. 22337C Department of the Treasury - Internal Revenue Service 

This information is to be typeset using Helvetica or Arial typeface. The type size is at the discretion of the contractor 

to fit the marginally punched area (should not be smaller than 6pt. type). Printing of the information is in Green, PMS 

343. 

Security Features: The 20% screen background must include the word “VOID”, which is revealed when the form is 

photocopied, even on lighter machine settings.

An Anti-Color Copier Security Field must demonstrate the ability to print the latent image without masking or the use 

of camouflage (which dilutes the effectiveness against color photocopying). 

The form must be printed on specially treated security paper that stains brown, or otherwise reacts when touched by 

fresh liquid bleach. 

Fluorescent fibers imbedded in the paper must be present and detectable when exposed to UV or “black” light. 

STOCK: The specifications of all stock furnished must be in accordance with those listed herein or listed for the 

corresponding JCP Code numbers in the "Government Paper Specification Standards No. 13" dated September 2019, 

and any subsequent amendments thereto. 

Defensa Basic IJ (Inkjet) Paper, Basis Weight 24. 

INKS: Green, PMS 343 and Black 

MARGINS: Follow printing media provided. Bleeds are not required. 

 
Jacket 771-343 Page 5 of 10 

GOVERNMENT TO FURNISH: The purchase order and digital files will be emailed to the contractor after award. 

One PDF file of IRS Form 9844. 

One manuscript copy of IRS Form. 

One previous PDF proof marked for placement of forms. Disregard the pin-feed holes on left and right sides. This will 

show the placement of the form and size of printed areas. 

IRS Form 6153 “Carton Shipping Label”. 

IRS Document 12321-LR “IRS Pallet Specifications Laser Roll Paper Program”. 

Bills of Lading for Bulk Shipments. 

Printing Media will be provided to contractor in Portal Document Format (PDF), generated from Adobe Acrobat 8.0 

or later (backward compatible to Adobe Acrobat 5.0), as a composite file (with all fonts embedded at the PDF level. 

DO NOT UNEMBED FONTS. 

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

deliverables) with the furnished material. The digital deliverables must be an exact representation of the final printed 

product and shall be returned on a CD-R disc, labeled with the: Production Date, Product Title, GPO Jacket No, 

ordering agency’s Requisition No. and contractor’s name. With the exception of Adobe Acrobat Portable Document 

Format (PDF) files, the contractor may not return PostScript files or any proprietary file formats different than those 

supplied as digital deliverables without expressed permission by the Government. 

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. 

Contractor is required to have Internet access, provided through their Internet Service Provider (ISP) with email and a 

web browser equivalent to Internet Explorer 6.0 or Netscape 4.0. 

Contractor is required to have Adobe Acrobat 7.0 Professional (or more recent) software (not Adobe Reader) and the 

capability to receive and open file attachments compressed into a WinZIP (.zip) file format. The contractor must 

furnish all e-mail addresses for the DHS to e-mail all electronic files, in order to avoid any lapse in service, at time of 

award. 

Contractor is required to output from furnished digital files at highest resolution. 

 

Basic Check of Furnished Electronic Media and Files: Prior to image processing, the contractor is responsible for 

checking all furnished electronic media files to insure that such files correctly generate for printing. The contractor 

must supply necessary trapping. Output must be generated on high resolution image processors. If any errors, media 

damage, or data corruption that might interfere with proper file imaging are discovered during inspection by the 

contractor, contact Joseph Moyer at (202) 317-6067 or joseph.j.moyer@irs.gov for new files. 

NOTE: Electronic files received in unusable condition will be replaced by IRS on an expedited basis. 

This Electronic Media and File check should identify any problem areas with the digital file submission and should 

include but not be limited to missing or damaged fonts, improper trim size and/or margins, only low-resolution files 

included for illustrations, and any improper color definition. The contractor is also responsible for adjusting copy for 

trim size and bindery attributes, and defining proper file output selection for the imaging device being used. All 

furnished files must be imaged as necessary to meet the assigned Quality Assurance Thorough Attributes Program 

(QATAP) level. 

Identification markings such as register marks, ring folios, rubber stamped jacket numbers, commercial identification 

marks of any kind, etc., form number, and revision date, carried on copy or film, must not print on finished product.

Contractor is required to have Adobe Acrobat 7.0 Professional (or more recent) software (not Adobe Reader) and the 

capability to receive and open file attachments compressed into a WinZIP (.zip) file format. The contractor must 

furnish all email addresses for the IRS to email all electronic files, in order to avoid any lapse in service, at time of 
Jacket 771-343 Page 6 of 10 

award. 

PRIOR-TO-PRODUCTION SAMPLE: Final copies must be produced as specified using the same material, with 

same equipment, in the same fashion that will be used in producing the approved prior to production sample. Do not 

print the entire quantity until receipt of the OK from the Government. If sample is approved without changes, the 

sample will become one of the final copies due to the customer. 

The Government will approve, conditionally approve, or disapprove the samples within two (2) workdays of the 

receipt thereof. 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 therefor. 

If the samples are disapproved by the Government, the Government, at its option, may require the contractor to submit 

additional samples for inspection and test, in the time and under the terms and conditions specified in the notice of 

rejection. Such additional samples shall be furnished, and necessary changes made, at no additional cost to the 

Government and with no extension in the shipping schedule. The Government will require the time specified above to 

inspect and test any additional samples required. 

In the event the additional samples are disapproved by the Government, the contractor shall be deemed to have failed 

to make delivery within the meaning of the default clause in which event this contract shall be subject to termination 

for default, provided however, that the failure of the Government to terminate the contract for default in such event 

shall not relieve the contractor of the responsibility to deliver the contract quantities in accordance with the shipping 

schedule. 

In the event the Government fails to approve, conditionally approve, or disapprove the samples within the time 

specified, the Contracting Officer shall automatically extend the shipping schedule in accordance with Contract Clause 

12, "Notice of Compliance with Schedules," of GPO Contract Terms (GPO Publication 310.2, effective December 1, 

1987 (Rev. 5-99)). 

Manufacture of the final product prior to approval of the sample submitted is at the contractor's risk. Samples will not 

be returned to the contractor. All costs, including the costs of all samples shall be included in the contract price for the 

production quantity. 

All samples shall be manufactured at the facilities in which the contract production quantities are to be manufactured. 

PRIOR-TO-PRODUCTION SAMPLE: The sample requirement for this contract is for one roll containing 10,000

sheets, per the specifications. Sample roll must be constructed as specified using the form, materials, equipment, 

and methods of production which will be used in producing the final product. 

Roll shall be manufactured at the facilities in when the contract production quantity is to be manufactured. Sample 

must be submitted prior to commencement of production of the contract quantity, in sufficient time to allow the 

Government testing of the sample and production and shipment in accordance with the shipping schedule. Samples 

will be tested for all security items listed in the "Security Features" section. The samples will also be reviewed for 

printing specifications listed under "DESCRIPTION". 

Deliver samples f.o.b. destination via traceable means (DO NOT SEND VIA USPS MAIL). Small packages for priorto-production sample sheets must have the material placed in an inside envelope, with that envelope placed in an outer 

shipping envelope or pack. 

Deliver pre-production sample via f.o.b. destination on or before August 16, 2023, as follows: 

One prior-to-production sample ROLL (10,000 sheets) to: 

Internal Revenue Service/CPS West 

112 North 700 West 

Building 4B 
Jacket 771-343 Page 7 of 10 

Ogden, UT 84404 

Attn: Joshua Kersey (801) 620-7211 

*Contractor MUST contact Joshua Kersey (801) 620-7211 when pre-production sample roll is shipped so that 

arrangements can be made for receipt. 

(Deliver by traceable means, signature required. Contractor MUST contact Joshua Kersey advising delivery of this 

roll.) 

100 prior-to-production samples (sheets) to: 

Internal Revenue Service 

1111 Constitution Avenue, NW 

Room 6550 

Washington, DC 20224 

Attn: Joseph Moyer (202) 317-6067 (Deliver by traceable means, signature required) 

Small packages for proofs or samples must have the material placed in an inside envelope, with that envelope placed 

in an outer shipping envelope or pack. 

There is a two-workday hold from receipt. Contractor cannot proceed without an "okay to print". 

PACKING: Each roll must be wrapped completed in at least 5 layers of moisture-proof plastic wrapping material of 

a strength that will ensure arrival at destination in a clean and un-manipulated condition. Rolls/pallets must be 

wrapped in black plastic to prevent cause exposure to the product while being transported. 

Rolls should be placed on edge and banded with plastic straps that will not break under normal shipping and handling 

conditions. Bands must go through the core in addition to over the top. Corner pads should be utilized on rolls to 

prevent damage from strapping. 

NOTE: All rolls must be secured on the 51” pallets by chocks to prevent rolling off the pallet. 

Small packages for proofs or samples must have the material placed in an inside envelope, with that envelope placed 

in an outer shipping envelope or pack. 

PALLETS: Pallets must be Type III, Group 2 or 3, two way flush pallet, and must conform to Federal Specifications 

NN-P-71. Size of pallet is to be 51 x 40”, with full entry on the 40” width. Pallets must also contain a double support 

joist 1-1/2” x 4” on each side of the pallet running the entire 51” length. Strict adherence to these dimensions is 

necessary to accommodate the storage requirements of IRS Distribution Centers. Please refer to IRS D12321-

LR/Laser Roll Pallet Instructions with the government furnished materials. 

Receipt of incorrect pallets may result in a charge for each incorrect pallet, which will be accessed against the 

contractor. This charge will cover additional costs incurred by IRS to re-palletize the shipment onto correct pallets. 

LABELING: All pallets and small packages used for shipping will require a label. Complete and copy the furnished 

shipping label and affix one to each side of the pallet and one on small packages according to the instructions at the 

top of the carton label sheet. Improper, partial or incorrect labeling may require the contractor to reimburse IRS for 

time spent correcting the affected labels. 

Each pallet must be marked with safety warnings for heavy roll paper, and procedures for safe handling information, 

such as moving the pallet and removing the rolls from the pallet. Product Usage Information should also be contained 

on each roll, how the unwind directions is marked, explanation of the start of good forms mark, etc. 

DEPARTMENTAL QUALITY COPIES: None required. 

In addition, a copy of the PURCHASE ORDER/SPECIFICATION along with the signed selection certificate, which 

will be furnished, must be included with the samples. 
Jacket 771-343 Page 8 of 10 

A copy of the Government-furnished certificate must accompany the voucher sent to the GPO, Financial Management 

Service, for payment. Failure to furnish the certificate may result in delay of processing the voucher. 

CUSTOMER DELIVERY NOTIFICATION: Contractor must notify the ordering agency on the same day that the 

product ships/delivers via e-mail to Joseph.J.Moyer@irs.gov. The subject line of this message shall be "Distribution 

Notice for Jacket 771-343". 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. 

DISTRIBUTION: Deliver f.o.b. contractor’s city*, as follows: 

*This order MUST deliver complete on or before November 3, 2023 via contractor's city. IRS will furnish a 

Government Bill of Lading (GBL) for shipment. Do not include any shipping charges in your submitted bid. The 

weight of the shipment MUST be furnished to IRS prior to issuance of the GBL. Call or email Joseph Moyer with the 

weight information at least two days prior to shipping. His phone number is (301) 728-0386 and his email is 

joseph.j.moyer@irs.gov

Deliver to: 

IRS, CPS West Site 

112 North 700 West 

Bldg. 4B M/S 8100 

Ogden, UT 84404 

Attn: Joshua Kersey (801) 620-7211 

10 sample sheets to: 

Internal Revenue Service 

1111 Constitution Avenue, NW 

Room 6550 

Washington, DC 20224 

Attn: Joseph Moyer (202) 317-6067 (Deliver by traceable means, signature required) 

All shipments will require a government bill of lading (GBL) for shipping. The contractor must provide the weight of 

the shipment before the GBL’s can be emailed to the contractor. Email wi.mp.traffic.management@irs.gov and 

joseph.j.moyer@irs.gov with weight information at least two (2) days prior to shipping. Joseph Moyer can be 

reached at (202) 317-6067. Production samples ship f.o.b. destination via traceable means. 

SCHEDULE: The purchase order and government furnished materials will be emailed to the contractor on July 24, 

2023. 

Prior-to-Production Sample Roll to deliver on or before August 16, 2023. 

Complete production and delivery MUST be made by November 3, 2023. 

All expenses incidental to returning materials, submitting proofs, and furnishing sample copies must be borne by the 

contractor. 

All Government Furnished Material must be returned within 10 workdays after delivery of the order. 
Jacket 771-343 Page 9 of 10 

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 award on that basis. If shipment 

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

BIDS: Bids 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 laser paper roll. The price for 

additional quantities must be based on a continuing run, exclusive of all basic or preliminary charges, (i.e., running 

rate not including makeready) and will not be a factor for determination of award. 

Bids must be received by the exact date and time specified. 

Bid Amount for Jacket 771-343: ____________________________________ 

Additional Rate (Per Roll) for Jacket 771-343: ________________________ 

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 undersign agree, if this bid is accepted with 

______ 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 point(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 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 all pages of “CONTRACTOR’S BID” section including 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) 
Jacket 771-343 Page 10 of 10 

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

THIS SECTION FOR GPO USE ONLY 

Certified by: ________ Date: _______ Contracting Officer: ________ Date:_________ 

 (Initials) (Initials) 

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