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COUNTY OF ORANGE <br />DEPARTMENT OF CENTRAL SERVICES <br />PO BOX 8181 <br />HILLSBOROUGH, NORTH CAROLINA 27278 <br />PROPOSAL FORM <br />The undersigned declares that they have examined the Request for Proposal and is informed fully with regard to <br />all terms and conditions pertaining thereto and agrees that if this proposal is accepted within ninety (90) days, the <br />undersigned will supply and deliver, as ordered, all items as required under this RFP at the prices set forth below: <br /># DESCRIPTION COST <br />1 TOTAL COST INCLUDING ALL PHASES FIRE AND RESCUE <br />ASSESSMENT AND PLAN ~ <br />Full Legal Name (print) Federal Ta~ayer Number (ID#) Contrado s Registration <br />Business Name / DBA Name / TA Name and Address Payment Address Purchase OrderAddress <br />CoMad NamelTitle Signature (ink) ~ <br />Telephone Number Fax Number Toll Free Number ~mail PuJdress <br />BID ENVELOPES TO BE MARKED, "RFP #5119, DUE 12 noon January 5, 2006:' <br />NOTE: INCLUDE ONE COPY OF THIS FORM IN A SEPARATE ENVELOPE ATTACHED TO THE <br />"ORIGINAL" <br />9 <br />