BID PRICE FORM
ITB# 2026-01
WATER TREATMENT PLANT BULK CHEMICALS

THIS BID PRICE FORM MUST BE PRINTED AND MANUALLY/WET SIGNED AS A PART OF YOUR OFFICIAL RESPONSE TO THE ITB. THIS BID PRICE FORM SUBMITTED IN ANY OTHER FORMAT SHALL NOT BE ACCEPTED. BID SUBMITTALS MAY NOT BE WITHDRAWN AFTER THE BID OPENNING.

Item #	Chemicals	Average Annual Usage	UOM	Bid Price ($US)	
1	CORROSION INHIBITOR (OT 3535)	2,000 GALLONS	GL		
2	AMMONIUM SULFATE (40%)	9,000 GALLONS	GL		
3	CALCIUM HYPOCHLORITE (HTH)	1,000 POUNDS	LB		
4	SODIUM CARBONATE (SODA ASH)	2,700 POUNDS	LB		
5	SODIUM HYDROXIDE (50%)	6,000 GALLONS	GL		
6	SULFURIC ACID (93%)	60,000 GALLONS	GL		
7	ANTISCLALANT (MEGAFLUX AC)	2,850 GALLONS	GL		
8	MEMBRANE CLEANER (CLEANFLUX BIO)	385 GALLONS	GL		
9	MEMBRANE CLEANER (AWC 234)	495 GALLONS	GL		
10	MEMBRANE CLEANER (AWC C-227)	2,970 POUNDS	LB		
11	CITRIC ACID	200 POUNDS	LB		

BIDDER’S CERTIFICATION

In witness whereof, the Proposer has executed this Bid Submittal Form for ITB# 2026-01 this 	 day of	,20	.

Signature of Individual/Title

Witness	Printed Name of Individual

ACKNOWLEDGMENT
STATE OF 	 COUNTY OF 	

Sworn to (or affirmed) and subscribed before me this 	 day of 	, 20	, by 		.
Physical presence 	 OR Online notarization	

Signature of Notary Public

[STAMP HERE]	State of 	

Personally Known 	 OR Produced Identification 	 Type of Identification Produced: