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Agreement Exhibit B <br />Clinical Laboratory of San Bernardino, Inc. Phone (909) 825.7693 Fax (909) 625 -7696 <br />LEGAL NAME OF COMPANY PHONE AND FAX NUMBERS <br />21881 Barton Road, Grand Terrace, CA 92313 <br />BUSINESS ADDRESS <br />Melinda Furnas Owner <br />PRINTED NAME OF AUTHORIZED AGENT a TITLE <br />8th, 2014 fur a8@Clinloal- lab.com <br />zo <br />95- 2504488 1088 <br />FEDERAL ID NUMBER (IF APPLICABLE) ENVIRONMENTAL LABORATORY ACCREDIDA "PION <br />PROGRAM CERTIFICATE NUMBER (FLAP #) <br />THIS FORM MUST BE COMPI.ETt D ANb INCLUDEb WITH THE PROPOSAL. <br />C� <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL SE CONSIDERED NONRESPONSIVE.� <br />RFP #14.017 —Water Quality Sampling & Testing Services <br />Page 22 <br />L 1226 <br />Non - Routine samples collected by City <br />9 <br />and tested by Consultant for General <br />60 <br />Each <br />$75.00 <br />$3,750.00 <br />Minerals As -Needed <br />Non- Routine samples collected by City <br />10 <br />and tested by Consultant for Inorganics <br />100 <br />Each <br />$100.00 <br />$10,000.00 <br />As- Needed <br />Total <br />$58,926.00 <br />Clinical Laboratory of San Bernardino, Inc. Phone (909) 825.7693 Fax (909) 625 -7696 <br />LEGAL NAME OF COMPANY PHONE AND FAX NUMBERS <br />21881 Barton Road, Grand Terrace, CA 92313 <br />BUSINESS ADDRESS <br />Melinda Furnas Owner <br />PRINTED NAME OF AUTHORIZED AGENT a TITLE <br />8th, 2014 fur a8@Clinloal- lab.com <br />zo <br />95- 2504488 1088 <br />FEDERAL ID NUMBER (IF APPLICABLE) ENVIRONMENTAL LABORATORY ACCREDIDA "PION <br />PROGRAM CERTIFICATE NUMBER (FLAP #) <br />THIS FORM MUST BE COMPI.ETt D ANb INCLUDEb WITH THE PROPOSAL. <br />C� <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL SE CONSIDERED NONRESPONSIVE.� <br />RFP #14.017 —Water Quality Sampling & Testing Services <br />Page 22 <br />L 1226 <br />