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Exhibit B-1 <br />"4 <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />ITEM FOR QUOTE FOR HOMELESS ENCAMPMENT AND DEBRIS CLEAN UP SERVICES <br />QUOTE STATEMENT and PROPOSER ITEM PRICING <br />EXHIBIT A <br />Certification <br />I certify that I have read, understand and agree to the terms and conditions of this quote. I have <br />examined the Scope of Services and am familiar with the scope of work and locations. I am familiar <br />with all the existing conditions and limitation that may impact work requests. I understand and agree <br />that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification <br />prior to the submission of my quote. <br />Quote Item Price <br />Pricing shall be based on the items listed below and described in the Scope of Services. <br />supplies, travel, mileage and fuel. Any special materials will be purchased by the Contractor only <br />after discussed and authorized by the City Projects Manager or designee in writing. The City has the <br />option to Purchase and provide materials. Special material will be purchased and/or by the City or the <br />City will reimburse the Contractor after authorization by City. <br />u t, d scei af W_,3 F <br />LEGAL NAME OF COMPANY <br />I Z i; 44 A/ S1. <br />BUSINESS ADDRESS <br />Mc,hcw--1 (,, ha <br />PRINTED NAME OF AUTHO IZED AGENT <br />7 <br />SIGNATURE OF AUTHQ�IIED AGENT <br />c. <br />(7m) 90`17a-2=(7"-fi4&0-Ve&- <br />rP}HONE AND FAX NUMBER <br />TITLE <br />DATE <br />36'-Q�TuC1r2 �'/7 <br />FEDERAL IDENTIFICATION NUMBER OR TAX ID (IF APPLICABLE) EMAIL ADDRESS <br />CONTRACTOR LICENSE LICENSE TYPE AND CONTRACTOR ID NUMBER (IF APPLICABLE) <br />THIS FORM MUST BE COMPLETED AND INCLUDED IN THE QUOTE. <br />QUOTES THAT DO NOT CONTAN THIS FORM WILL BE CONSIDERED NON -RESPONSIVE <br />City of Santa Ana Public Works Agency <br />Request for Quotes for Homeless Encampment and Debris Clean Up Services <br />11 of 17 <br />