Request For Quote (Rfq) Form (Page 2 of 2) in pdf

EXHIBIT L

REQUEST FOR QUOTE (RFQ) FORM

ITQ #3514T02, “Traffic Engineering Data Count”

Date RFQ Sent: ________________________

Engineering District(s): ______________________

Completed RFQ Due: ________________ AM/PM

on: ____________________________

Quote Opening:

________________ AM/PM

on: ____________________________

You have been identified as a Qualified Contractor for this District’s Traffic Engineering Data Count Services. Please

complete the information below and return it to the address at the bottom of this form. The form MUST be received no later

than the date and time shown above. Opening of the quotes received by the deadline shall take place at the date and time

shown above.

This Request for Quote (RFQ) incorporates by reference the Terms and Conditions of the Traffic Engineering Data Count

ITQ #3514T02.

Purchase Order Term: _______________________

If you are the lowest responsive and responsible bidder, you shall receive a Purchase Order as your Notice to Proceed.

DO NOT respond to request to commence traffic data count until the Validity Start Date shown on the Purchase Order.

DO NOT respond to request to commence traffic data count unless you receive a Purchase Order.

District(s) to Service:

Anticipated Start Date: __________________

Anticipated End Date: _____________________

Contractor Name (as it appears on your Contract):

_____________________________________________________________

SAP Vendor #: ________________

Contract #: ______________

If bidding on this project, complete Cost Submittal Workbook information and return form to address below:

COST SUBMITTAL:

Cost for 24 Hour Counts: _____________

Cost for 48 Hour Counts: _____________

Total cost per count (24 hour + 48 hour):______________

If not bidding on this project, check box and return form to address below:

I understand that the above price would be in effect only for the period shown on the Purchase Order if selected as the

lowest responsive and responsible bidder.

Contractor’s Signature (ink): __________________________________________

Date: _________________

Contractor’s Title: _____________________________________________________________________

MUST BE SIGNED BY CONTRACTOR’S AUTHORIZED SIGNATORY

Attach completed Cost Submittal form to RFQ response and submit to:

PA Department of Transportation

ATTN:

Request For Quote (Rfq) Form Page 2