Company Form 36 for Lake County Indiana
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LAKE COUNTY FORM 36: July 1, 2020


OUT OF FUND # ___________, DEPARTMENT # _______________,

ACCOUNT # __________________.


1. Potential offeror may contact the following for further information:




2. The general type of service being requested is identified by an X in one of the following four boxes

▢ Specialty Services are those such as legal and accounting where the vendor is engaged to provide the skill to address the subject area.

▢ Specific Repair Services are those services where the vendor returns the tangible article to its operational function and form.

▢ Maintenance Services are those services to tangible items to keep a product in good operating condition.

▢ Other Services are those of a particular type of help or assistance that are not the production of a tangible item

3. The detail of the service requested in described in Attachment A.

4. The General Instructions to Offerors and County Forms 1, 2, 3, 4, 5, 6 and 7 are made a part of these specifications as if fully set out herein.

5. All offerors shall examine the specifications thoroughly to familiarize themselves with the requirements.

6. The following pertain to the submission of the offer:

A. An offeror shall submit an offer bond or certified check in the amount of five (5%) percent of the offer for each quarter for offers over one hundred thousand ($100,000.00) dollars.

1) The offer bond or certified check shall be for the benefit of or be made payable to “The Board of Commissioners of the County of Lake, State of Indiana.”

2) All certified checks of unsuccessful Offerors shall be returned upon selection of the successful offeror.

B. The County of Lake is committed to the principle of affirmative action. Each offeror must execute an affidavit on a form provided by the County of Lake acknowledging that the offeror has its own affirmative action program that is in compliance with any and all applicable federal/state/local laws and interpretive court decisions.

C. The County hereby affirms its policy that no vendor, contractor, grant recipient, or anyone receiving public funds or benefits of any kind shall discriminate on the basis of race, religion, color, disability, sexual orientation, gender identity, national origin, ancestry, age, or United States military service status, and any breach of this Policy shall continue to be considered a material breach of the relationship with the County.

7. The County is committed to providing equal employment opportunities for all applicants and employees. Employment decisions shall be made without regard to sexual orientation or gender identity.

8. The offeror shall submit if required by State law a photocopy of the “State of Indiana Office of the Secretary of State Certificate of Existence” indicating that they have filed their most recent annual report as required by Indiana law.

9. The offeror shall include in their offer packet the original offer and one photocopy of the offer.

10. These provisions apply to the successful offeror:

A. Have workmen’s compensation coverage as required by State Law.

B. The Contractor shall carry public liability and property damage insurance in amounts as outlined below :

▢ Seven hundred thousand dollars ($700,000) for the death or injury to one (1) person in anyone (1) occurrence and five million dollars ($5,000,000) for injury to or death of all persons in the occurrence as required by IC 34-13-3-4

▢ provide public liability and property damage insurance in the amount of One Million Dollars ($1,000,000) for each occurrence and Two Million Dollars ($2,000,000) in the general aggregate.

C. The Board, Lake Board offices and their elected officials,Lake Board Departments, and Lake Board employees shall be named as an additional insured and be fully protected.

D. Indemnify and hold harmless any and all entities to include but not limited to the County of Lake, The Board of Commissioners of the County of Lake, it’s elected officials, it’s officers, it’s employees, and or its agents for any and all expenses or charges to include attorney fees which these entities or persons might have to pay by virtue of the successful offerors actions, non-actions, or performance

E. As an independent contractor, the vendor accepts all responsibility for all injuries and accidents that meet the definition of “reportable” as defined by OSHA. Further, the vendor shall report to IOSHA, via a first report, and list on the contractor’s annual OSHA 300 Report, all accidents that occur while performing services for or to Lake County.

13. The Lake County Commissioners will select the offer which they feel in their sole judgment best meets the type of service being requested for the cost being required by the vendor.

14. The provisions of I.C. 5-22 is applicable, and the contract with the successful offeror shall include all provisions required, the cited statutes and any other provisions required by law.

15 Where language of these specifications conflicts with any requirements previously established by the Board of Commissioners of the County of Lake, the terms of these specifications shall apply

ALL OF WHICH IS APPROVED THIS_________DAY OF __________________, 20_______


______________________________________________           VENDOR SIGNATURE:______________________________________________

______________________________________________           BY:______________________________________________________________



LAKE COUNTY AUDITOR: ______________________________________________


PURCHASING CODE_____________

REQUESTED BY______________________________

DATE REQUESTED___________________________

TELEPHONE NUMBER_______________________

E MAIL_____________________________________

1. These descriptions and instructions are made a part of the General Provisions for the Specification for the acquisition of a Service.

2. The details and components of the specific service being solicited must be developed by the office or department requesting the service. The specific service covered by this Attachment A is as follows:




3. The service is required within the following time frame:

A. Daily

B. Weekly

C. Monthly

D. Delivery on the following specific date:____________________________________

E. Other: Please specify __________________________________________________

4. The party selected to deliver the service will utilize its expertise to provide the product or complete the task in accordance with generally accepted provisions of those providing the service.

5. A party who desires to submit an offer will include the following in order to identify specifically the cost to the county of the service to be provided:

A. The total cost to provide the service including all labor hours and material costs if that is the method the vendor selects to present its offer.

B. An hourly rate that will be charged and billed with a not to exceed total of ours of labor plus a not to exceed costs of materials against which the vendor will bill actual material costs as they are incurred.

C. Any other method that the vendor deems appropriate to present its offer to the Lake County Commissioners.

6. There will be no addendums or additions to the described service to be provided unless agreed to inwriting by the county and the vendor with a specific cost identified for the additional work.

7. The vendor will select the method it deems necessary in order to provide the requested service.

8. If completion of the service requires the participation of Lake Cunty elected officials, departments, offices, or employees, these must be identified by the offeror in the response submitted