Okaloosa County BOCC — July 7, 2015 — Bid Sheet Test America

BID SHEET ) 6-1-15 Date Submitted: BID#: RFB WS 44-15 BID TITLE: Laboratory Services for Water and Waste Water Testing Drinking Water Matrix Total: $1,461 Non-Portable Water Matrix Total: $2,536 Solid and Chemical Materials Total: $224 Remarks: Unit prices are indicated above since there are no quantities provided. ANTI-COLLUSION STATEMENT: The below signed respondent has not divulged to, discussed or compared his bid with other respondents and has not colluded with any other respondent or parties to bid whatever. (Note: No premiums, rebates, or gratuities permitted either with, prior to, or after any delivery of materials. Any such violation will result in the cancellation and/or return of material (as applicable) and the removal from bid list(s). TestAmerica Laboratories, Inc. CZ‘\/ A~ Respondent’s Company Name Authorized Signatu're — Manual 3355 McLemore Drive Charles Newton Authorized Signature — Typed Pensacola, FL 32514 Laboratory Director Address Title (850) 474-1001 (850) 474-4789 Phone # Fax # 23-2919996 charles.newton@testamericainc.com Federal ID # or SS # E-mail address RFB WS 44-15 Form-H OKALOOSA COUNTY