BIDDER REGISTRATION FORM



Instructions

1. The Bidder Registration Form must be filled out in its entirety and submitted via email or fax, with an authorized officer’s signature, to:

Levitan & Associates, Inc.

Attn: Sara Wilmer

100 Summer Street, Suite 3200

Boston, MA 02110

(617) 531-2818 x15 (phone)

(617) 531-2826 (fax)

aicrfp@

2. The faxed / emailed versions of the document must be received by 12:00 pm CPT on April 12, 2011.

Once the Bidder Pre-Qualification and Registration form has been received by the respective parties, the person listed as the Contact Person on Bid Day will be notified by fax accompanied by a confirmation email.

If the Bidder Pre-Qualification and Registration Form is not complete, the person listed as the Contact Person on Bid Day will notified of this by email, and will have until 5:00 pm CPT on April 12, 2011 to correct the deficiency.

No late Bidder Pre-Qualification and Registration Forms will be accepted under any circumstances.

Note: No Pre-Bid Letter of Credit is required for the June 2011 Capacity procurement

Contact Information

(Please fill in all fields)

Legal Name of Bidding Entity:      

Business Address:      

     

     

Bidding Entity Officer

Name:      

Title:      

Telephone:      

Fax:      

E-mail:      

Contact Person on Bid Day

(if different from Bidding Entity Officer)

Name:      

Telephone:      

Fax:      

E-mail:      

Address to which contracts should be sent for execution if Bidding Entity is awarded capacity:

Same as Business Address

Attn Bidding Entity Officer

Attn Contact Person on Bid Day

Other

     

     

     

     

Officer Certification

The Following Certifications Must Be Agreed to and Signed by the Officer Representing the Bidding Entity. 

The undersigned is an officer of the Bidding Entity with the authority to sign contracts and bind the Bidding Entity to its bid in the 2011 IPA AIC Capacity RFP for June 2011.

The undersigned certifies that the bid to be submitted by the Bidding Entity under the Capacity RFP was prepared and will be submitted independently of any bid submitted by any other bidder under the Capacity RFP.

The undersigned agrees that the bid(s) submitted by the Bidding Entity under the Capacity RFP is binding, firm and irrevocable for the product offered.

If the Bidding Entity’s bid(s) under the Capacity RFP is selected by the Procurement Administrator and approved by the Illinois Commerce Commission, the Bidding Entity is obligated to execute the Capacity RFP Confirmation Agreement by 12:00 noon CPT on April 20, 2011 and to supply the PRCs bid for the period June 1, 2011 through June 30, 2011.

______________________________________ ________________________

Signature of Officer Date

______________________________________ ________________________

Signature and Seal of Notary Public Date

Notices

This information will be used to populate Confirmation Agreements with winning bidders

Seller:      

(Full legal name of the entity that will be party to the contract)

All Notices:

Street:      

City / State / Zip:      

Attn:      

Phone:      

Facsimile:      

Duns:      

Federal Tax ID Number:      

Invoices:

Attn:      

Phone:      

Facsimile:      

Email:      

With a copy to:

Attn:      

Phone:      

Facsimile:      

Email:      

Payments:

Attn:      

Phone:      

Facsimile:      

Wire Transfer:

BNK:      

ABA:      

ACCT:      

ACH Transfer:

BNK:      

ABA:      

ACCT:      

Credit and Collections:

Attn:      

Phone:      

Facsimile:      

Email:      

With additional Notices of an Event of Default or Potential Event of Default to:

Attn:      

Phone:      

Facsimile:      

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