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DocuSign Envelope ID: F4D38498-6182-495F-9F57-49F44D76229A <br /> FORM A-OFFEROR IDENTIFICATION&AUTHORIZED SIGNATORY <br /> Invitation No.: AM10-14 <br /> (DO NOT handwrite this Form. Information must be typed in,) <br /> Invitation Title: Ambulances,EMS&Other Special Service Vehicles <br /> Offeror Company: <br /> (Legal naive of business which will appear on contract,if awarded) <br /> Offeror Status: r Manufacturer Dealer/Distributor �� Other <br /> Single Offeror Acting Multiple Offerors <br /> Response Type(1): � Alone Or As Lead ( Acting Jointly <br /> Contract Signatory(2): Title: <br /> Mailing Address(3): <br /> Street/PO Box City State&Zip <br /> Physical Address: <br /> Street City State&Zip <br /> Phone: Fax: <br /> Email Address: <br /> Federal Tax ID No.: Web Page URL: <br /> (1)If Joint Offering,all parties must submit a signed Form A. A contract will be offered to each. <br /> (2)Person who will sign final contract documents if an award is made. <br /> (3)Address to which final contract documents would be sent for signature. <br /> Member Contact Information <br /> Contact Person(4): Title: <br /> Mailing Address: <br /> Street/PO Box City State&Zip <br /> Physical Address: <br /> Street City State&Zip <br /> Toll Free Phone: Fax: <br /> Email Address: <br /> (4)Person who End Users will contact for product information and to get pricing quotes. <br /> The Signatory below,on behalf of Offeror: <br /> -Acknowledges having thoroughly reviewed the Invitation; <br /> -Attests to having the authority to sign this response and commit Offeror to honor all requirements; <br /> -Makes,under penalty of perjury,all required Offeror Certifications as detailed in General Terms; <br /> -Certifies that all information provided in this Response is true and correct. <br /> Signature: Title: <br /> Printed Name: Date: <br />