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Randolph County                                                                                                                     Bid 07-1001

Due Date:  Thursday, October 25, 2007, 3:00P.M.                                                         EMS Ambulances

_____________________________________________________________________________________

BID FORM

BID NO. 07-1001

I, (We), the undersigned after reading and fully understanding the terms, conditions and specifications of Request for Bid No. 07-1001, agree to furnish a firm fixed price (excluding tax).

   UNIT         EXTENDED

ITEM NO.DESCRIPTIONQTY.    COST   COST

     1.Type I, Class I                   2$____________       $___________

DODGE (preferred) 2007 or Newer

Ambulance

     2.Tax          $____________       $___________

                                 GRAND TOTAL                     $____________       $___________

Delivery Date: _______________________

COMPANY NAME: ___________________________________________________________

ADDRESS: __________________________________________________________________

CITY: ___________________________   STATE: _____________ ZIP CODE: __________

TELEPHONE: __________________________   FAX:  ______________________________

EMAIL ADDRESS: ___________________________________________________________

PRINT NAME: _______________________________________________________________

AUTHORIZED SIGNATURE: _________________________________________________

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