E 104 Form PDF Details

E 104 Form is a tax form used for reporting employee benefits. Most commonly, it is used to report employer-provided health insurance coverage. The form must be completed by both the employee and the employer, and must be filed with the IRS. The E 104 Form helps the IRS determine whether or not an employee is eligible for certain tax breaks and subsidies. If you are an employer, it is important to understand how to complete this form correctly. If you are an employee, it is important to understand what information needs to be reported on the form. Let's take a closer look at the E 104 Form and what it entails.

QuestionAnswer
Form NameE 104 Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesca3916 form, e104 skjema, form e104, e104 obrazac

Form Preview Example

FORM E-104 (Rev. 11-03)

RETURN ONE COPY ONLY

DATE: 2/29/08

MISSOURI DEPARTMENT OF TRANSPORTATION

THIS IS NOT

 

GENERAL SERVICES

AN ORDER

 

830 MoDOT Drive - P.O. BOX 270

 

 

 

JEFFERSON CITY, MISSOURI 65102

 

 

REQUEST FOR QUOTATION

 

 

 

 

 

 

DUE BY: 03/06/2008

F.O.B. Destination

 

 

 

 

 

 

TIME REQUIRED 30 Days

FOR DELIVERY

TO:

QUOTATION NO. 4-080306AB

BUYER NAME:

Amy Bailey

TELEPHONE:

573-522-6188

Please quote on this form your lowest prices covering material specified and all information requested above.

DELIVERY

LOCATION : ST.LOUIS COUNTY

QUANTITY UNIT

DESCRIPTION

UNIT

AMOUNT

 

 

PRICE

 

This is a quote for furnishing “Commuter Lot Surveillance For 2 Commuter Parking Lots In St. Louis County, Missouri” as listed in the attached specifications.

Please see attached pricing pages to submit quote. Please submit pric- ing on the pricing pages that are provided.

This quote will be issued on an “All or None” bases and NO

SUBSTITUTIONS will be accepted.

Please Include Freight and or Shipping In Pricing

Please fax this quotation back to Amy Bailey at 573-526-1218 by

The end of business on March 06, 2008.

VENDOR NOTE: The Bidder must be in compliance with the laws regarding conducting business in the State of Missouri. Within ten (10) business days of notification, the Bidder will need to provide a copy of his/her Missouri Secretary of State’s “Certificate of Good Standing” prior to the issuance of any contract or initial purchase order by the Missouri Department of Transportation (MoDOT)

(SEE ATTACHED FOR TERMS AND CONDITIONS)

Telephone No.

Fax No.

Request No.

Federal I.D. No.

Is your firm MBE certified?

Yes

 

Firm Name

 

Address

 

By (Signature)

 

Title

No

Is your firm WBE certified?

Yes

No

List all agencies your firm is currently certified with.

PRICING PAGE

Quote for furnishing “Commuter Lot Surveillance”

COMPLETE AND SUBMIT WITH YOUR SIGNED BID FORM AND OTHER REQUIRED DOCUMENTATION.

NOTE ON QUANTITIES AND BRAND IDENTIFICATION:

ALL BIDS SHOULD INDICATE THE BRAND & PART NUMBER TO BE CONSIDERED.

 

 

 

 

 

 

 

Item

 

 

 

Unit of

 

Extended

#:

Description:

Mfg. No. or Brand

Qty:

Issue:

Unit Price:

Total:

001

Commuter Lot Surveillance Equipment

 

12

Months

 

 

 

According To The Specifications Below.

 

 

 

 

 

 

LOCATION: 2 LOTS IN ST. LOUIS CO.

 

 

 

 

 

 

For bid to be considered, the vendor must

 

 

 

 

 

 

include manufacturer, make, model num-

 

 

 

 

 

 

ber and descriptive literature of detection

 

 

 

 

 

 

system being submitted.

 

 

 

 

 

 

Delivery of equipment must be within 30 day

 

 

 

 

 

 

of acceptance of purchase order.

 

 

 

 

 

**MINUMUM SPECIFICATIONS

FOR COMMUTER LOT SURVEILLANCE EQUIPMENT**

Surveillance equipment shall be priced by monthly rate, which shall include the following in the price.

Installation of a minimum of 4 cameras at each location

satellite internet connection bills at each site

ongoing service/modifications of the site

replacement of all parts /equipment when needed

staffed helpdesk to insure system uptime

documentation and delivery of requested client backups

plus all specifications listed below

MoDOT WILL NOT be responsible for any other charges or costs:

Complete Setup and Installation of the camera system and client site.

Setup, free on-going maintenance, and consolidated payment of satellite internet connection needed at each site to manage the data to the contractor’s office and for remote client viewing. All maintenance, troubleshooting and monthly service bills will be the re- sponsibility of the contractor and included in the cost of the monthly pricing. Must include full service/complete management of a remote IP video recoding system and archiving via the internet from central server/helpdesk. Set monthly charges include full in- stallation and complete costs of IP camera solution.

Service/Repair/Replacement/Lens Cleaning/Adjustment to Equipment Position. New equipment costs when needed. The contrac- tor is fully responsible for all aspects of the equipment.

Review and Written Documentation of Request Video Events. This shall include but not be limited to full time staff dedicated to receiving daily requests for backup and review. Management of all archived video recordings for client. Any footage that is sus- picious in nature will be sent directly to MoDOT. There should also be an online web portal set up where the contractor can up- load and view video for the client to stream or download from their computer after it has been reviewed by the contractor. All video backup requests shall be delivered via website download, secure e-mail, and/or and easy to view CD

Monitoring Service:

Contractor must have specific software set up on every site that alerts them by email and/or text if a site goes down. Contractor must log in every day to every camera and system in the field to make sure they are focused properly, backing up right and there is no obstruction or vandal to the cameras. Remote management of surveillance sites with on demand system alerts, (daily system health and focus checks) and 24 hour priority response if site troubleshooting is needed.

PREFERENCE IN PURCHASING PRODUCTS

DATE: ______________________________

The bidders attention is directed to Section 34.076 RSMo 2000 which gives preference to Missouri corpora- tions, firms, and individuals when letting contracts or purchasing products.

Bids/Quotations received will be evaluated on the basis of this legislation.

All vendors submitting a bid/quotation must furnish ALL information requested below.

FOR CORPORATIONS:

State in which incorporated:

______________________________________________________________________________

FOR OTHERS:

State of domicile:

______________________________________________________________________________

FOR ALL VENDORS:

List address of Missouri offices or places of business:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

 

 

THIS SECTION MUST BE COMPLETED AND SIGNED:

FIRM NAME:

______________________________________________________________

ADDRESS:

 

___________________________________________________________________

CITY:

_______________________________ STATE: ________ ZIP: _________

BY (signature required):

_____________________________________________________________

Federal Tax I.D. #:

__________ if no Federal Tax I.D. # - list Social Security #: _________

NOTE: For bid/quotation to be considered, the “Preference in Purchasing Products” form must be on file in the General Services (Procurement) Division and must be dated in the current calendar year.

________________________________________________________________________

Name of the Bidders Firm

___________________________________________________________________

Signature of Contractor’s Authorized RepresentativeDate Signed

Missouri Highways and Transportation Commission

Standard Bid/Proposal Provisions, General Terms and Conditions and Special Terms and Conditions

STANDARD SOLICITATION PROVISIONS

a.The Missouri Department of Transportation (MoDOT) reserves the right to reject any or all bids/quotes/proposals, and to accept or reject any items thereon, and to waive technicalities. In case of error in the extension of prices in the bid/quote/proposal, unit prices will govern.

b.All bids/quotes/proposals must be signed with the firm name and by a responsible officer or employee. Obligations assumed by such signature must be fulfilled.

c.By virtue of statutory authority, a preference will be given to materials, products, supplies, provisions and all other articles produced, manufactured, made or grown, within the State of Missouri.

d.Time of delivery is a part of the consideration and, if not otherwise stated in the solicitation documents, must be stated in definite terms by the Bidder/Offeror and must be adhered to. If time varies on different items, the Bidder/Offeror shall so state.

e.If providing bids/quotes/proposals for commodities, the Bidder/Offeror will state brand or make on each item. If bidding or proposing other than the make, model or brand specified, the manufacturer's name, model number or catalog number must be given.

f.For bids/proposals of $25,000 or more, no bids/proposals by telephone, telegram or telefax will be accepted.

g.The date specified for the returning of bids/quotes/proposals is a firm deadline and all bids/quotes/proposals must be received at the designated office by that time. The Department does not recognize the U.S. Mail, Railway Express Agency, Air Express, or any other organization, as its agent for purposes of accepting proposals. All proposals arriving at the designated office after the deadline specified will be rejected.

GENERAL TERMS AND CONDITIONS

General Performance

a.This work is to be performed under the general supervision and direction of the Missouri Department of Transportation (MoDOT) and, if awarded any portion of the work, the Contractor agrees to furnish at his own expense all labor and equipment required to complete the work, it being expressly understood that this solicitation is for completed work based upon the price(s) specified and is not a solicitation for rental of equipment or employment

of labor by MoDOT, and MoDOT is to have no direction or control over the employees used by the Contractor in performance of the work.

Deliveries

a.Unless otherwise specified on the solicitation documents or purchase order, suppliers shall give at least 24 hours advance notice of each delivery. Delivery will only be received between the hours of 8:00 a.m. to 3:00 p.m., Monday through Friday. Material arriving after 3:00 p.m. will not be unloaded until the following workday. No material will be received on Saturday, Sunday or state holidays.

b.If the prices bid herein include the delivery cost of the material, the Contractor agrees to pay all transportation charges on the material as FOB - Destination. Freight costs must be included in the unit price bid and not listed as a separate line item.

c.Any demurrage is to be paid by the Contractor direct to the railroad or carrier.

Nondiscrimination

a.The Contractor shall comply with the Regulations relative to nondiscrimination in federally-assisted programs of the Department of Transportation, Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and made a part of this contract.

b.All solicitations either by competitive bidding or negotiation made by the Contractor for work to be performed under a subcontract, including procurements of materials or leases of the Contractor's obligations under this contract and the Regulations, will be relative to nondiscrimination on the grounds of race, color, or national origin.

1)Sanctions for Noncompliance: In the event of the Contractor's noncompliance with the nondiscrimination provisions of this contract, MoDOT shall impose such contract sanctions as it or the Federal Highway Administration may determine to be appropriate, including, but not limited to:

i.withholding of payments to the Contractor under the contract until the Contractor complies, and/or,

ii.cancellation, termination or suspension of the contract, in whole or in part.

Contract/Purchase Order

a.By submitting a bid/quote/proposal, the Bidder/Offeror agrees to furnish any and all equipment, supplies and/or services specified in the solicitation documents, at the prices quoted, pursuant to all requirements and specifications contained therein.

b.A binding contract shall consist of: (1) the solicitation documents, amendments thereto, and/or Best and Final Offer (BAFO) request(s) with any changes/additions, (2) the Contractor's proposal and/or submitted pricing, and (3) the MHTC’s acceptance of the proposal and/or bid by purchase order or post-award contract.

c.A notice of award does not constitute an authorization for shipment of equipment or supplies or a directive to proceed with services. Before providing equipment, supplies and/or services, the Contractor must receive a properly authorized purchase order and/or notice to proceed.

d.The contract expresses the complete agreement of the parties and performance shall be governed solely by the specifications and requirements contained therein. Any change, whether by modification and/or supplementation, must be accomplished by a formal contract amendment signed and approved by and between the duly authorized representative of the Contractor and the duly authorized representative of the MHTC, by a modified purchase order prior to the effective date of such modification. The Contractor expressly and explicitly understands and agrees that no other method

and/or no other document, including correspondence, acts, and oral communications by or from any person, shall be used or construed as an amendment or modification.

Subcontracting

a.It is specifically understood that no portion of the material or any interest in the contract, shall be subcontracted, transferred, assigned or otherwise disposed of, except with the written consent of MoDOT. Request for permission to subcontract or otherwise dispose of any part of the work shall be in writing to MoDOT and accompanied by documentation showing that the organization which will perform the work is particularly experienced and

Page 1 of 3

Accepted: 9/29/03

Updated: 6/4/07

Missouri Highways and Transportation Commission

Standard Bid/Proposal Provisions, General Terms and Conditions and Special Terms and Conditions

equipped for such work.

b.Consent to subcontract or otherwise dispose of any portion of the work shall not be construed to relieve the Contractor of any responsibility for the production and delivery of the contracted work and the completion of the work within the specified time.

c.All payments for work performed by a subcontractor shall be made to the Contractor to whom the contract was awarded and the purchase order

issued.

Invoicing and Payment

a.MoDOT is exempt from paying Missouri Sales Tax, Missouri Use Tax and Federal Excise Tax. However, the Contractor may themselves be responsible for the payment of taxes on materials they purchase to fulfill the contract. A Federal Excise Tax Exemption Certificate will be furnished to the successful Bidder/Offeror upon request.

b.Each invoice should be itemized in accordance with items listed on the purchase order and/or contract. The statewide financial management system has been designed to capture certain receipt and payment information. Therefore, each invoice submitted must reference the purchase order number and must be itemized in accordance with items listed on the purchase order. Failure to comply with this requirement may delay processing of invoices for payment.

c.Unless otherwise provided for in the solicitation documents, payment for all equipment, supplies, and/or services required herein shall be made in arrears. The Missouri Highways and Transportation Commission (MHTC) shall not make any advance deposits.

d.The MHTC assumes no obligation for equipment, supplies, and/or services shipped or provided in excess of the quantity ordered. Any authorized quantity is subject to the MHTC’s rejection and shall be returned at the Contractor's expense.

e.The MHTC reserves the right to purchase goods and services using the state-purchasing card.

Applicable Laws and Regulations

a.The contract shall be construed according to the laws of the State of Missouri. The Contractor shall comply with all local, state, and federal laws and regulations related to the performance of the contract.

b.The Contractor must be registered and maintain good standing with the Secretary of State of the State of Missouri and other regulatory agencies, as may be required by law or regulations. Prior to the issuance of a purchase order and/or notice to proceed, the Contractor may be required to submit to MoDOT a copy of their current Authority Certificate from the Secretary of State of the State of Missouri.

1)Prior to the issuance of a purchase order and/or notice to proceed, all out-of-state Contractors providing services within the state of Missouri must submit to MoDOT a copy of their current Transient Employer Certificate from the Department of Revenue, in addition to a copy of their current Authority Certificate from the Secretary of State of the State of Missouri.

c.The exclusive venue for any legal proceeding relating to or arising, out of the contract shall be in the Circuit Court of Cole County, Missouri.

Executive Order

a.The Contractor shall comply with all the provisions of Executive Order 07-13, issued by the Honorable Matt Blunt, Governor of Missouri, on the sixth (6th) day of March, 2007. This Executive Order, which promulgates the State of Missouri’s position to not tolerate persons who contract with the state engaging in or supporting illegal activities of employing individuals who are not eligible to work in the United States, is incorporated herein by reference and made a part of this Agreement.

1)“By signing this Agreement, the Contractor hereby certifies that any employee of the Contractor assigned to perform services under the contract is eligible and authorized to work in the United States in compliance with federal law.”

2)In the event the Contractor fails to comply with the provisions of the Executive Order 07-13, or in the event the Commission has reasonable cause to believe that the contractor has knowingly employed individuals who are not eligible to work in the United States in violation of federal law, the Commission reserves the right to impose such contract sanctions as it may determine to be appropriate, including but not limited to contract cancellation, termination or suspension in whole or in part or both.

3)The Contractor shall include the provisions of this paragraph in every subcontract. The Contractor shall take such action with respect to any subcontract as the Commission may direct as a means of enforcing such provisions, including sanctions for noncompliance.

Preferences

a.In the evaluation of bids/quotes/proposals, preferences shall be applied in accordance with Chapter 34 RSMo. Contractors should apply the same preferences in selecting subcontractors.

b.By virtue of statutory authority, RSMo. 34.076 and 34.350 to 34.359, a preference will be given to materials, products, supplies, provisions and all other articles produced, manufactured, made or grown within the State of Missouri. Such preference shall be given when quality is equal or better and delivered price is the same or less.

1)If attached, the document entitled “PREFERENCE IN PURCHASING PRODUCTS” should be completed and returned with the solicitation documents.

2)If attached, the document entitled “MISSOURI DOMESTIC PRODUCTS PROCUREMENT ACT” should be completed and returned with the solicitation documents. Applies if bid is Twenty-Five Thousand Dollars ($25,000.00) or more.

c.In the event of a tie of low bids, the MHTC reserves the right to establish the method to be used in determining the award

Page 2 of 3

Accepted: 9/29/03

Updated: 6/4/07

Missouri Highways and Transportation Commission

Standard Bid/Proposal Provisions, General Terms and Conditions and Special Terms and Conditions

Remedies and Rights

a.No provision in the contract shall be construed, expressly or implied, as a waiver by the MHTC of any existing or future right and/or remedy available by law in the event of any claim by the MHTC of the Contractor's default or breach of contract.

b.The Contractor agrees and understands that the contract shall constitute an assignment by the Contractor to the MHTC of all rights, title and interest in and to all causes of action that the Contractor may have under the antitrust laws of the United States or State of Missouri for which causes of action have accrued or will accrue as the result of or in relation to the particular equipment, supplies, and/or services purchased or produced by the Contractor in the fulfillment of the contract with the MHTC.

c.In the event a Contractor becomes involved in, or is threatened with, litigation with a subcontractor or supplier as a result of such direction, the Contractor may request MoDOT to enter into such litigation to protect the interests of the MHTC, and, in addition, the Contractor may request the United States to enter into such litigation to protect the interests of the United States.

Cancellation of Contract

a.The MHTC may cancel the contract at any time for a material breach of contractual obligations or for convenience by providing the Contractor with written notice of cancellation. Should the MHTC exercise its right to cancel the contract for such reasons, cancellation will become effective upon the date specified in the notice of cancellation sent to the Contractor.

b.If the MHTC cancels the contract for breach, the MHTC reserves the right to obtain the equipment, supplies, and/or services to be provided pursuant

to the contract from other sources and upon such terms and in such manner as the MHTC deems appropriate and charge the Contractor for any additional costs incurred thereby.

Bankruptcy or Insolvency

a.Upon filing for any bankruptcy or insolvency proceeding by or against the Contractor, whether voluntary or involuntary, or upon the appointment of a receiver, trustee, or assigned the benefit or creditors, the Contractor must notify MoDOT immediately. Upon learning of any such actions, the MHTC reserves the right, at its sole discretion, to either cancel the contract or affirm the contract and hold the Contractor responsible for damages.

Inventions, Patents, and Copyrights

a.The Contractor shall defend, protect, and hold harmless the MHTC, its officers, agents, and employees against all suits of law or in equity resulting from patent and copyright infringement concerning the Contractor's performance or products produced under the terms of the contract.

Inspection and Acceptance

a.No equipment, supplies, and/or services received by MoDOT pursuant to a contract shall be deemed accepted until MoDOT has had reasonable opportunity to inspect said equipment, supplies, and/or services.

b.All equipment, supplies, and/or services which do not comply with the specifications and/or requirements or which are otherwise unacceptable or defective may be rejected. In addition, all equipment, supplies, and/or services which are discovered to be defective or which do not conform to any warranty of the Contractor upon inspection (or at any later time if the defects contained were not reasonably ascertainable upon the initial inspection) may be rejected.

c.The MHTC reserves the right to return any such rejected shipment at the Contractor's expense for full credit or replacement and to specify a reasonable date by which replacements must be received.

d.The MHTC’s right to reject any unacceptable equipment, supplies, and/or services shall not exclude any other legal, equitable or contractual

remedies the MHTC may have.

Warranty

a.The Contractor expressly warrants that all equipment, supplies, and/or services provided shall: (1) conform to each and every specification, drawing, sample or other description which was furnished to or adopted by MoDOT, (2) be fit and sufficient for the purpose expressed in the solicitation documents, (3) be merchantable, (4) be of good materials and workmanship, and (5) be free from defect.

b.Such warranty shall survive delivery and shall not be deemed waived either by reason of the MHTC’s acceptance of or payment for said equipment, supplies, and/or services.

Status of Independent Contractor

a.The Contractor represents itself to be an independent Contractor offering such services to the general public and shall not represent itself or its employees to be an employee of the MHTC. Therefore, the Contractor shall assume all legal and financial responsibility for taxes, FICA, employee fringe benefits, workers’ compensation, employee insurance, minimum wage requirements, overtime, etc., and agrees to indemnify, save and hold the MHTC, its officers, agents and employees harmless from and against any and all losses (including attorney fees) and damage of any kind related to such matters.

Indemnification

a.The Offeror shall defend, indemnify and hold harmless the Commission, including its members and department employees, from any claim or liability whether based on a claim for damages to real or personal property or to a person for any matter relating to or arising out of the Offeror's performance of its obligations under this Agreement.

Page 3 of 3

Accepted: 9/29/03

Updated: 6/4/07