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SAVINGS <br />fFor internal information uurooses only Not a factor In award of this contract) <br />Bidder is required to furnish the percent (%) savings in prices off8red in this bid comparedto prices <br />that would be paid by the purchaser without benefit of a contract resulting from this bid. <br />BID PRiCE5 OFFERED AVERAGE 25' % LOWER TITAN: <br />,~'S(CIRCLE ONE OFTIIE FOLLOWINGNUMBERS) <br />1. <br />3. <br />Price that would be obtained without benefit of a contract resulting from this bid. <br />Manufacturer's current wholesale price list. <br />Other (specify) <br />If you are aminority/woman and/or small owned business please complete the following. This <br />information will assist us in identifying your minority/women and/or small owned business in our <br />database: <br />This form is not intended to certify vour fixm. <br />ETHNIC GROUP STATUS: Specify the ethnic group and percentage of ownership.of the <br />person(s) who owns and controls (management & operational) 51% of more of the firm. <br />African-American Male _% Asian-American ~ Male _% <br /> Female _°/u Female _% <br />Hispanio-American Male _% Native-American Male _% <br /> Female, _% Female _% <br />Caucasian-Female _% - <br />African-American: any black individual of the racial groups of Africa; Asian-American: persons whose origins <br />aze from Japan, China, the Philippines, Vietnam, Korea, Samoa, Guam, the IJ.S. Trust Territories of the Pacific, <br />Northern Marianas, Laos, Cambodia, Taiwan, India, Patdstan, and Bangladesh; Hispanic-American: persons of <br />Spanish or Portuguese torture including Mexico,South America, Central America, or the Caribbean Islands; <br />Native-American: persons having origins in any of the original peoples of North America; Caucasian Female: <br />women that aze not included in the above categories. <br />Are you currently certified as a minority vendor with a government entity? /~ <br />With what agency(s) <br />(Please attach copy of certification certificate with your response with this bid/quotation J <br />Bidder <br />08-04Q <br />