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RFq 2015-8027; Generator Services

ATTACHMENT A

Contractor’s Fee Submission Form

PARTS/SUPPLIES AND MATERIALS

Description Percentage added to Contractor’s wholesale cost

Supplies and Parts __________ %

Equipment __________ %

“On Shelf” Products __________ %

AMP Address

Manufac-

turer Model Spec

Serial/

Accessories

TransferSwitch

Manufacturer Model Spec

Quote forMaintenan

for one yea

80

Trailer Mounted/Warehouse1088 W Liberty Kohler 50ROZJ 189303 318129 - - - $_______

211Beechwood330 Forest Ave Kohler 50ROZJ81 189303 318131 Kohler K-168341-225 K040536 $_______

211Maple Towers601 Maple Ave Kohler 200ROZD81 132409 338720 Kohler K-168341-260 L.S. A1733 $_______

212Riverview House2538 Hackberry St Kohler 50ROZJ81 189303 318130 Kohler K-168341-150 FA95343-2 $_______

212San Marco1601 Madison Road Kohler 80ROZJ 189519 338478 Kohler K-164341-0150 K50962 $_______

213Park Eden2610 Park Ave Kohler 50ROZJ71 189303 318211 Kohler K-166341-150 K43178 $_______

213President784 Greenwood Ave Kohler 80ROZJ 189546 396057 Kohler K-564341-0260 K78698 $_______

213 Redding Apts3700 Reading Rd Kohler 100ROZJ81 189629 385131 Kohler K-168341-400 K71789 $_______

215Stanley Row 'A'1609 Linn Kohler 125ROZJ81 189708 295954 ASCO E940360047XC 36645-3001 $_______

215Stanley Row 'B'-11609 Linn Kohler 180ROZJ81 189928 338415 Kohler K-168341-260 K50680 $_______

215 Stanley Row 'B' -2 Onan 60DGCV 90379M 1970647699 Onan 07225 H970646914 $_______

216Pinecrest3951 W Eighth St Kohler 50ROZJ81 189303 318132 Kohler K-168341-150 K422122 $_______

218

Marquette/EnglishWoods1999 Sutter Ave Generac

9A10245-Sor 32858-12638 125KW AD201267SNA

GeneracASCO

90A04245-WE940326097-C

99463015672277480FP89241 $_______

AH

Baldwin Grove1111 SpringfieldPike Generac SD0050G363 50KW 2094845 - SD0050G363 - $_______

AH

Reserve on S.Martin7363 Main Street Kohler 230REOZJE

GM66100-GA4 SGM322DJZ Kohler

KSP-DCVA-0400S SGM3228LL $_______

Total Annual Cost (firm, fixed price inclusive of all costs) for two maintenance services per year: $_______Do you offer 24-hour on call service to respond to emergencies? _____

Service rates: $__________/hour between 8 am and 5 pm Monday through Friday (firm, fixed rate inclusive of all costs)$__________/hour for after hours or holidays

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RFq 2015-8027; Generator Services

DISCOUNT OFFERED FOR EARLY PAYMENT: ______ % if invoice paid within ____ days of

properly submitted invoice as stated in the RFq.

Performance Standards.For each time the Contractor is late to arrive for a scheduled service, the Contractor’s fee may be reduced

10%.

The Property Manager or Maintenance Supervisor may waive the fee reduction at their discretion after

discussing extenuating circumstances with the Contractor. Such waiver shall be in writing at the time of

the service.

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RFq 2015-8027; Generator Services

PROPOSER’S STATEMENT

The undersigned proposer hereby states that by completing and submitting this Form and all other

documents within this submittal, he/she is verifying that all information provided herein is, to the best of

his/her knowledge, true and accurate, and that if the Authority discovers that any information enteredherein to be false, such shall entitle the Authority to not consider or make award or to cancel any awardwith the undersigned party. Further, by completing and submitting the response, the undersigned is

thereby agreeing to abide by all terms and conditions pertaining to this RFq as issued by the Authority,

either in hard copy or on the noted Internet System. Upon issuance of award to proposer, CMHA isaccepting Contractor’s offer contained in the submittal and this Fee Submission. No other contractual

documents will be necessary or accepted unless specifically expressed in the notification of contract

commencement. The Contract commences upon CMHA’s issuance of a Notice of ContractCommencement, which may or may not be in the form of a copy of the Contract Documents, unless said

notice expressly states otherwise, in those instances, Contract Commencement occurs in accordance withthe notification. Pursuant to all RFq Documents including attachments, this Fee Submission Form, and

pursuant to all Documents submitted, the undersigned proposes to supply the Authority with theservices described herein for the fee(s) submitted pertaining to this RFq.

Date: __________________, 2015

Company: _________________________________________________________

Address: __________________________________________________________

City, State, Zip _____________________________________________________

By: ______________________________________________________________

(Signature of Offerer)

By: _____________________________ Title: _________________________

(Print Name)

Fed Tax ID: ___________________________