Reso 2002-480 - Laserfiche WebLink

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""Inll;. vr r~\"Ir\I"'1"'\ &.ICrI"'\r\IMC"'1 vr 1l'V'\,,,,,rvn;II'\IIVN COMMON CARRIER FREIGHT RATE OPTION FORM AND RATE AFFIDAVIT CCNlR'C1S IOANS1R'\1ICN co.::. 07/01 TO: Florida Department of Transportation Tallahassee, Florida Ortract I\b: E-6964 Financial Project 10: 409268-1-52-01 The Contractor must select 0 either Option "An or Option "B", and hereby agrees that the Common Carrier Freight Rate adjustment clauses of Article 9-4 of the Specifications do not apply unless Option "A" is selected, this Option and Affidavit Form is properly executed and is accompanied by signed quotations from an authorized freight agent(s). OPTION IIA" The Contractor desires that the Common Carrier Freight Rate adjustment clauses of Article 9-4 of the Specifications apply to this contract for the following applicable materials (supply information only on material for which adjustment is claimed). Only one rate, origin and destination may be shown for each material listed as used for the basis of bid: o Material Frt. Rate OriQin Destination Limerock Shell Screeninas Asoh. Mix) ITEM NO. Aggr. Grade Aggr. Grade Aggr. Grade Asoh. Mix) ITEM NO. Aggr. Grade Aggr. Grade I(Asoh. Mix) ITEM NO. Aggr. Grade Aggr. Grade " " " "Use additional lines for other applicable materials by current specs. OPTION ~ The Contractor desires to exclude all materials listed above for the contract from the Common Carrier Freight Rate adjustment clauses of Article 9-4 of the Specifications. (Seal) Authorized Si~nature: I Name & Title (Print): .H.edvr H, Orh-'2-- .SiQnature: Name & Title (Print): "In the event of a Partnership both siQnature and printed name of 2 partners must be affixed.