Company Form 95 for Lake County Indiana
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STATE FORM 95: July 1, 2020
State Form 95 - Bid, Offer or Proposal for Sale or Lease of Materials

(Defined at I.C. 36-1-2-9.5)

(Please type or print)


1. Governmental Unit:________________________________________________

2. County:__________________________________________________________

3. Bidder (Firm):_____________________________________________________



4. Telephone Number:_________________________________________________

5. Agent of Bidder (if applicable):________________________________________

Pursuant to notices given, the undersigned offers bid(s) to________________________________________________ (Governmental Unit) in accordance with the following attachments(s) which specify the class or item number or description, quantity, unit, unit price, and total amount.

The contract will be awarded by classes or items, in accordance with specifications. Any change or alterations in the items specified will render such bid void as to that class or item. Bidder promises that he has not offered nor received a less price than the price stated in his bid for the materials included in said bid. Bidder further agrees that he will not withdraw his bid from the office in which it is filed. A certified check or bond shall be filed with each bid if required, and liability for breach shall be enforceable upon the contract, the bond or certified check or both as the case may be.


Signature of Bidder or Agent

Bid Offer or Proposal

Attach separate sheet listing each item bid based on specifications published by governing body. Following is an example of the bid format:

Class or Item
Unit Price

Non-Collusion Affidavit



COUNTY OF____________________

The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding not to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.

He further says that no persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.


Bidder (Firm)


Signature of Bidder or Agent

Subscribed and sworn to before me this_______________day of__________________, 20______


Notary Public

My Commission Expires:_____________________________________________

County of Residence:________________________________________________


There now being sufficient unobligated appropriated funds available, the contracting authority of________________________________(Governmental Unit) hereby accepts the terms of the attached bid for classes or items numbered__________________________________ and promises to pay the undersigned bidder upon delivery the price quoted for the materials stipulated in said bid.


Contracting Authority Members: