BID PRICE FORM
ITB# 2026-03
CARTRIDGE FILTERS FOR POTABLE WATER

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 BID SUBMITTALS MAY NOT BE WITHDRAWN AFTER THE BID OPENNING.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 #	Cartridge Filters	Average Annual Usage	UOM	Bid Price per Unit ($US)	Extended Bid Price ($US)	
1	Pre-Membrane 1-Micron	610 Units				
2	Pre-Membrane 5-Micron	2745 Units				
Total	3355 Units				

BIDDER’S CERTIFICATION

In witness whereof, the Proposer has executed this Bid Submittal Form for ITB# 2026-03 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: