REQUEST FOR QUOTE
FOR:
New 6130R John Deere (or Equivalent) Cab Tractor with Loader
Ready Package and Panorama Glass Roof
Due Date: Tuesday, February 23, 2016 at 2:00 P.M. local time
Released By: Owen Hartnett, Procurement Coordinator
Email Address: [email protected]
Vendor’s Name:
GENERAL INFORMATION
Below is a checklist provided to assist you. Please note that these instructions may not contain all applicable
requirements. Careful reading of this request is critical. Failure to follow these instructions, or those printed
throughout this form, may lead to the rejection of your quote. It is not necessary to return this page with your
response.
A. _______ In order to receive an Award, you must complete the Survey A and B forms; therefore, if you are a
new vendor you will need to complete the Survey A and B forms prior to an award.
B. _______ Type or print legibly in black ink, all requested information, including prices and extensions, as
well as the correct vendor information. Clearly detail in writing, any deviation from, or exception
taken, to the stated specifications. The Specifications and Compliance form must be completed
and returned.
C. _______ The Indianapolis Airport Authority will only accept signed quotes. The quote may be rejected if it
contains any alterations or erasures that are not initialed by the signer of the quote. The Non-
Collusion Certification is included and must be signed and returned with your quote. When you
sign the Signature Page, you are agreeing to the general conditions, specifications, certifications,
and other documents of this package. The quote may be rejected if it is returned without the
appropriate forms signed (i.e. Pricing Response Form, Non-Collusion Certification, etc.). Facsimile
quotes are NOT ACCEPTABLE AT THIS TIME.
D. _______ Do not add, delete, or modify, any contractual terms and conditions. Terms of the award will be
those listed in this package.
E.
F.
_______
_______
If you are not willing to accept a split award (partial order), your request must include the
statement “Quoting all or none.” The Indianapolis Airport Authority reserves the right to accept or
reject any or all quotes, or any part thereof, and to award the items separately, all to one vendor or
to make a multiple-award. ITEMS NOT QUOTED – If a vendor does not desire to submit a quote for
an item, you should indicate “NO QUOTE” in the unit column for that item.
All inquiries and requests for information regarding this Invitation to Bid must be submitted in
writing to:
Email: [email protected]
No later than 12:00 p.m. Local Time on Tuesday, February 16, 2016. The Authority reserves the
right to judge whether any questions should be answered. If responses are provided, the
responses will be written. Copies of the written responses will be issued via Addendum and will be
available on the Indianapolis Airport website on Wednesday, February 17, 2016. No negotiations,
decisions or actions shall be initiated by any Respondent as a result of any verbal discussion with
any representative of the Authority or with any Authority employee.
G. _______ The request must be received and clocked in by or prior to the Due Date and Time indicated
above. Each quote must be sent via email. The email must clearly indicate the following
information:
1. The notation “QUOTE”
2. The Description: RFQ (Tractor)
3. The Due Date and Time
1 2016-005-Q-G
H. _______ Email package to: [email protected]
Owen Hartnett
Procurement Department
Indianapolis Airport Authority
Re: RFQ – Tractor
IT IS THE RESPONSIBILITY OF THE VENDOR TO MAKE SURE THAT QUOTE RESPONSES ARE RECEIVED
BY THE PROCUREMENT DIVISION ON OR BEFORE THE DESIGNATED DATE AND TIME.
IN ORDER TO PROTECT THE INTEGRITY OF THE QUOTE PROCESS, FAILURE TO PROPERLY IDENTIFY
YOUR QUOTE ACCORDING TO THE ABOVE INSTRUCTIONS MAY RESULT IN AN AUTOMATIC
DISQUALIFICATION FROM CONSIDERATION.
2 2016-005-Q-G
RESPONSE TO: Request For Quote
Issued by Indianapolis Airport Authority
Email Quote to: [email protected]
Vendor Name
and Address:
Line Quantity Item No/Description Unit Cost (Each) Total Cost
01 1
New 6130R John Deere (or Equivalent) Cab
Tractor with Loader Ready Package and
Panorama Glass Roof
Date of Quote
Typed Name of Representative: Telephone Number:
Shipment must be FOB
Destination. When can you
ship?
Pricing includes all cost to supply and deliver product to the designated Authority's location(s) to include but not
be limited to transportation, freight, certification, etc.
Name of Quote: New 6130R John Deer (Or
Equivalent) Cab Tractor with Loader Ready
Package and Panorama Glass Roof
Signature:
The Indianapolis Airport Authority reserves the right to accept or reject, in whole or in part, the foregoing quote.
To be valid, all quotes must be signed manually.
Representative Signature certifies no quote on this request has been submitted by Officers, representatives or an
affiliate of this firm under another name. Further, we have read and agree to the specifications, terms and
conditions for this request.
Title of Representative:
If additional information is necessary, email the following: Owen Hartnett, Procurement Department at
Please Follow Instructions Included In Solicitation Package
Due Date: Tuesday, February 23 at 2:00 p.m.
(local time)
**NOTICE: All prices are assumed valid for ninety (90) days from Quotation date unless otherwise noted. When a
quote is submitted, the Vendor is agreeing to meet or exceed specifications, unless noted on the specification
worksheet.
3 2016-005-Q-G
(2016) CAB TRACTOR
A NEW 6130R JOHN DEERE (OR EQUIVALENT) CAB
TRACTOR WITH LOADER READY PACKAGE AND
PANORAMA GLASS ROOF
SPECIFICATIONS AND COMPLIANCE FORM
DESIGNED TO
PROCURE ONE (1) NEW MECHANICAL FRONT WHEEL DRIVE, 6130R
JOHN DEERE (OR EQUIVALENT) CAB TRACTOR WITH LOADER READY
PACKAGE AND PANORAMA GLASS ROOF
FOR THE
INDIANAPOLIS INTERNATIONAL AIRPORT
4 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 2 of 16 John Deere 6130R (or equivalent)
RFQ
This specifications and compliance form contemplates the furnishing and delivery of one (1) new
6130R John Deere (or equivalent) Cab Tractor. Specifications are for a mechanical front wheel
drive (MFWD), 6130R John Deere (or equivalent) cab tractor with loader ready package and
panorama glass roof and indicate in general the type, size, and quality desired. Only quotes
submitted with this Specifications and Compliance Form completed and returned will be accepted.
Equipment specifically mentioned by name is used to establish the minimum standards of quality
and performance. Equipment not herein mentioned but possessing the same degree of quality or
greater and capable of producing the same results as those specified, will be considered. If an
exception to an item is made with this belief then substantiation must be provide in the comments.
The Indianapolis Airport Authority reserves the right to make the final determination of quality
and performance. The Indianapolis Airport Authority reserves the right to reject or to accept none,
all, or part of any quote submitted; to waive technicalities in any or all quotes; and to accept the
most advantageous quote as to price, quality, and adaptability for the work performed. These
specifications require the doing of all things necessary or proper for, or incidental to the furnishing
of said unit.
01: COMPLIANCE
Item Item Description Compliance
01:001 Quotes for the new 6130R John Deere (or equivalent) cab tractor will not be accepted on
any forms but this one. No Yes
Comments:
01:002 If any part of an item is not in compliance then that item must be marked “No” and an
exception to that item is taken. An explanation can be provided in the comments. No Yes
Comments:
01:003
An additional comments section is provided at the end of this form if more space is needed
to complete any comment. Entries in the additional comment section should follow the
order of the specifications and compliance form and be labeled with the original section
title, number, and page of the item (e.g. 01: Compliance, Item 01:003, Page 1: Note
additional comments).
No Yes
Comments:
01:004
If tractor is not compliant with any item marked "Yes" for compliance then quoter will be
responsible at quoter’s expense to make any and all changes necessary to make tractor
compliant.
No Yes
Comments:
01:005
If an item seems to have exclusionary specifications of another item then the item providing
the Indianapolis Airport Authority with the higher quality or greater performance will be
provided unless directed otherwise by addendum.
No Yes
Comments:
01:006 The Indianapolis Airport Authority reserves the right to make the final determination of
quality and performance. No Yes
Comments:
5 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 3 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
01:007
The Indianapolis Airport Authority reserves the right to reject or to accept none, all, or part,
of any quote submitted; to waive technicalities in any or all quotes; and to accept the most
advantageous quote as to price, quality, and adaptability, for the work performed.
No Yes
Comments:
01:008 These specifications require the doing of all things necessary, or proper for, or incidental to,
the furnishing of said unit complete and fully functional even if an item is omitted. No Yes
Comments:
01:009 Any quote submitted must be valid for 90 days from the date of quote opening. No Yes
Comments:
01:010
It is the Indianapolis Airport Authority’s intent to purchase high quality commercial
application equipment at the lowest cost available. Therefore, in the Indianapolis Airport
Authority’s desire to choose the lowest responsive and responsible quoter, price will not be
the overriding factor used to evaluate any quotes submitted although price will be an
essential element.
No Yes
Comments:
01:011
The headings and section titles of this specifications and compliance form are inserted only
as a matter of reference and in no way define, limit, or describe the scope or intent of any
provision hereof.
No Yes
Comments:
02: GENERAL
Item Item Description Compliance
02:001
All parts and components of this unit shall be new and of the size, material, and strength to
sustain the maximum load limits and severe operating conditions encountered in
commercial and off-road operations, while resulting in minimum wear and failure.
No Yes
Comments:
02:002 No experimental or untried equipment, unit/model, or component may be proposed or
utilized in the final unit quoted. No Yes
Comments:
02:003 All materials, parts, and components used shall be heavy duty and manufactured and/or
treated to resist rust, corrosion, and wear. No Yes
Comments:
02:004 This tractor will be driven on highways and other public roadways. This tractor shall
comply with all applicable federal, state, and local quality and safety standards. No Yes
Comments:
6 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 4 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
02:005
All electrical wiring shall be either harness, cable, split loomed, or shrink wrapped, and
shall be watertight and weatherproof. All junction boxes shall be watertight and
weatherproof. Wiring shall be secured every 18 inches by means of clips and/or hangers.
No Yes
Comments:
02:006 All electrical wiring shall be color-coded; wire numbered, matching drawing schematics and
terminal strip; and labeled what it is used for every three inches. No Yes
Comments:
02:007
All items of design and equipment not listed in these specifications, but involved in carrying
out their intent, are required to be furnished by the quoter, the same as if these items were
specifically mentioned and described in these specifications. This includes but is not
limited to software.
No Yes
Comments:
02:008
The unit must be fully assembled and tested for full functionality prior to delivery by the
manufacturer’s qualified representative. If any component of the unit is found to be
incomplete, missing, or NOT fully functional then unit will not be delivered.
No Yes
Comments:
02:009 Proof of tests by an operational and component check list with date performed and signature
of tester(s) is required with the delivery of the unit. No Yes
Comments:
02:010
The tractor with attachments and all components will be delivered to the Indianapolis
Airport Authority, at 2000 South Banner Avenue, Indianapolis, IN 46241 fully functional
and ready to operate within 90 days of the award of quote. (If an exception is made a
delivery date must be provided in the comments. Exceptions beyond 01 November of the
current year may not be accepted.)
No Yes
Comments:
02:011
The successful quoter shall pay liquidated damages to the Indianapolis Airport Authority in
the amount of $200 per day beyond the 30th day and $500 per day beyond the 90th day from
the stated delivery date that delivery of the new 6130R John Deere (or equivalent) cab
tractor with attachments and all components fully functional and ready to operate is not
made. Liquidated damages are understood and accepted. NO EXCEPTIONS ALLOWED.
No Yes
Comments:
02:012
In lieu of liquidated damages the quoter at no expense to the Indianapolis Airport Authority
may provide a temporary substitute tractor capable of providing at least the same degree of
functionality as and until delivery of the unit ordered. Any liquidated damages accrued
prior to or after delivery of the temporary substitute tractor must still be paid to the
Indianapolis Airport Authority. NO EXCEPTIONS ALLOWED.
No Yes
Comments:
7 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 5 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
02:013 Any outstanding balance of liquidated damages owed at the sole discretion of the
Indianapolis Airport Authority may be deducted from any payment. No Yes
Comments:
02:014
Payment will occur after the Indianapolis Airport Authority has had time to inspect the
mower for compliance with the specifications and compliance form and any discrepancies
have been corrected. Inspection will not start until delivery of complete mower and all
components. While the Indianapolis Airport Authority will try to keep the process as short
as possible the quoter is strongly encouraged to allow adequate time for this at times lengthy
process. Payment will be net 30 days from date of confirmation of compliance with the
specifications and compliance form.
No Yes
Comments:
03: TRACTOR CHASSIS
Item Item Description Compliance
03:001 Tractor supplier shall supply a statement on their company letterhead. The statement shall
contain an affirmation that the tractor meets all functionality and capacity requirements. No Yes
Comments:
03:002
The tractor proposed in this quote must be a new 6130R John Deere or equivalent of the
manufacturer’s latest model and design. State the manufacturer, year, model, and any of
the model’s descriptive qualifiers, (e.g. Case IH/2014/Maxxum 125, New Holland/2016/
TS6.130, or John Deere/2016/6130R).
No Yes
Comments:
03:003 The tractor proposed in this quote must have been manufactured for use in the USA with
English as the primary language. No Yes
Comments:
03:004
The tractor to have an AutoQuad PLUS ECO or equivalent shift on-the-go 24F/24R
transmission (25 mph/40 kmh) with auto de-clutch function. Includes left-hand reverser
and declutch button on shift lever.
No Yes
Comments:
03:005 The engine shall be compliant with the most current EPA emission standards and
requirements. State compliance level. No Yes
Comments:
03:006 The tractor to have a premium cab with right-hand console. No Yes
Comments:
8 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 6 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:007 The tractor to have a Generation 4 CommandCenter or equivalent. Right-hand console shall
contain a single CommandCenter display with controls and video input. No Yes
Comments:
03:008 Tractor shall have a bottle holder and two cup holders in the cab, one cup holder in the
right-hand console and one cup holder right-hand A-post mounted. No Yes
Comments:
03:009 Cab to have automatic temperature controls. No Yes
Comments:
03:010 Cab to have an overhead storage bin. No Yes
Comments:
03:011 Cab to have an overhead reading light. No Yes
Comments:
03:012 Cab to have a coat hook. No Yes
Comments:
03:013 Cab to have an inner rear view mirror. No Yes
Comments:
03:014 The tractor must be equipped with left-hand and right-hand wide angle heated mirrors
electrically adjustable and telescopic. No Yes
Comments:
03:015 Cab to have a multi power outlet strip and a power outlet socket. No Yes
Comments:
03:016 The tractor must be equipped with an air suspended seat with seat belt. No Yes
Comments:
03:017 Cab to have an instruction seat mounted on the left side of the operator with seat belt. No Yes
Comments:
03:018 The instruction seat shall be easily and quickly folded away for easier entering and exiting
of the cab. No Yes
Comments:
03:019 The seat shall be easily and quickly folded upright or easily and quickly folded down to
create a level area for personal items. No Yes
Comments:
9 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 7 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:020 The tractor shall have left-hand and right-hand steps. No Yes
Comments:
03:021 The tractor shall have left-hand and right-hand foot step accent lights. No Yes
Comments:
03:022 The tractor to have panorama left-hand and right-hand doors. No Yes
Comments:
03:023 The tractor to have a panorama windshield. No Yes
Comments:
03:024 Cab to be equipped with front and rear roller blinds. No Yes
Comments:
03:025 Cab to be equipped with front and rear windshield washers and wipers. No Yes
Comments:
03:026 Cab to be equipped with a heated rear window defrost to provide visibility quickly and
simply by removing the condensation from the rear window. No Yes
Comments:
03:027 The tractor proposed in this quote must have a panorama glass roof. No Yes
Comments:
03:028 The tractor proposed in this quote must be equipped with base lighting plus the premium
panorama roof light package. No Yes
Comments:
03:029 Panorama roof light package to include 2 xenon front roof mounted adjustable work lights. No Yes
Comments:
03:030 Panorama roof light package to include 2 LED rear roof mounted adjustable work lights. No Yes
Comments:
03:031 Panorama roof light package to include 2 HB3 halogen side roof mounted fixed work lights. No Yes
Comments:
03:032 Panorama roof light package to include 2 HB3 rear fender mounted adjustable work lights. No Yes
Comments:
10 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 8 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:033 Panorama roof light package to include 1 beacon light. No Yes
Comments:
03:034 Cab to include 7-pin signal interface socket. No Yes
Comments:
03:035 Cab to include ITEC Headland Management System or equivalent. No Yes
Comments:
03:036 Cab to include a swinging drawbar with hammerstrap. No Yes
Comments:
03:037 Tractor includes deluxe receiver mounting bracket. No Yes
Comments:
03:038 Tractor to be JDLink or equivalent capable including cab wiring harness. No Yes
Comments:
03:039
Tractor to have an AM/FM stereo radio with weather band and standard features including
remote radio controls on right-hand console, remote mounted auxiliary input jack, speakers,
and external antenna.
No Yes
Comments:
03:040
Tractor hydraulics to be closed-center pressure and flow compensated (PFC) 30 GPM (114
L/min) pump out with 26.4 GPM (100 L/min) flow at one selective control valve (SCV)
(45ccm) system.
No Yes
Comments:
03:041 The tractor to be equipped with four (4) rear premium, 450-Series, electronic SCV's having
premium ISO breakaway couplers with high-pressure relief lever. No Yes
Comments:
03:042 Tractor shall be equipped with an electrohydraulic activated 540/1000 RPM, 1-3/8 inch
independent rear reversible power take-off (PTO) with master shield. No Yes
Comments:
03:043 Tractor to have telescopic draft links with ball end category 2/3N. No Yes
Comments:
03:044 Tractor to have a center link with ball end category 3. No Yes
Comments:
11 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 9 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:045 Tractor to have sway control blocks to protect the transmission housing against horizontal
movement of the draft links. No Yes
Comments:
03:046 Tractor shall be equipped with seat activated PTO warning. No Yes
Comments:
03:047 There shall be a right-hand and left-hand rear PTO switch. No Yes
Comments:
03:048 Tractor to have a flanged rear axle. No Yes
Comments:
03:049 Tractor to be equipped with Michelin 18.4R38 146A8 R1W Radial (460/85R38 149A8
R1W Radial) rear tires. No Yes
Comments:
03:050 The tractor proposed in this quote must have a mechanical front wheel drive (MFWD) axle. No Yes
Comments:
03:051 Tractor to be equipped with Michelin 14.9R24 126A8 R1W Radial (380/85R24 131A8
R1W Radial) front tires. No Yes
Comments:
03:052 The tractor shall have large and flexible full-coverage ridged front fenders with a wide
range of adjustments for different tread settings. No Yes
Comments:
03:053 Front fenders shall easily be removed from tractor, by removing no more than two bolts. No Yes
Comments:
03:054 The tractor to have right-hand and left-hand 1-piece side and rear fender extensions to give
additional coverage to the tractor fenders and will be adapted to tire width. No Yes
Comments:
03:055 The tractor proposed in this quote must be equipped with a at minimum 3-function electrical
independent control valve loader ready package. No Yes
Comments:
03:056 Loader ready package to include a at minimum 3-function electrical midstack control valve. No Yes
Comments:
12 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 10 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:057 Loader ready package to include a 3-function electronic joystick with five reconfigurable
buttons and an activated rocker switch. No Yes
Comments:
03:058 Loader ready package to include at a minimum six (6) hydraulic hoses from mid-mount
tractor valve to loader mounting frame. No Yes
Comments:
03:059 Loader ready package to include the tractor half of single point hydraulic coupler. No Yes
Comments:
03:060 Loader ready package to include the loader mounting frame. No Yes
Comments:
03:061 Loader ready package to include a hood guard. No Yes
Comments:
03:062 Tractor to have a removable tool box on the left side as you enter the cab. No Yes
Comments:
03:063 Tractor to be equipped with a cold start package. No Yes
Comments:
03:064 Cold start package to include an electrical cable for 230V / 110V socket. No Yes
Comments:
03:065 Cold start package to include an engine block heater, 110V. No Yes
Comments:
03:066 Cold start package to include a transmission oil pump heater, 110V. No Yes
Comments:
03:067 Cold start package to include a charge pump heater. No Yes
Comments:
03:068 The tractor fuel tank shall be located under the left-hand side of the cab with the diesel
exhaust fluid (DEF) tank molded into the fuel tank. No Yes
Comments:
03:069 The single molded combination tank shall have separate color coded filler caps for each
product, diesel fuel color coded green and DEF color coded blue. No Yes
Comments:
13 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 11 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:070 The single molded combination tank shall be conveniently located to allow refilling of
either tank comfortably from ground level. No Yes
Comments:
03:071
The single molded combination tank shall have a diesel fuel tank with a minimum capacity
of 51.5 gallons (195 L) and a DEF tank with a minimum capacity of 3.4 gallons (13 L).
State tank capacities.
No Yes
Comments:
03:072 The tractor to have a 12 volt electrical system. No Yes
Comments:
03:073 The tractor to be equipped with a 240 amp alternator. No Yes
Comments:
03:074 The tractor to be equipped with a 174 ah battery. No Yes
Comments:
03:075 The tractor to be equipped with battery boost terminals located on the right-hand side of the
tractor. No Yes
Comments:
03:076 The tractor to be equipped with a battery circuit breaker to protect the battery from damage
and to avoid a discharged battery from leaving monitors or radios switched on. No Yes
Comments:
03:077 The battery isolator switch for the battery circuit breaker shall be integrated into the ignition
circuit. No Yes
Comments:
03:078 The tractor shall be equipped with a 242 pound (110 kg) front weight support. No Yes
Comments:
03:079 The tractor shall be equipped with a backup alarm that sounds whenever the transmission is
placed into reverse. No Yes
Comments:
03:080
The tractor engine shall be a PowerTech PSS or equivalent, 4 Cylinder, 275 cu in. (4.5 L)
displacement developing up to 130 hp (96kW) with dual series turbocharger with fixed
geometry first stage-variable geometry second stage, air-to-air aftercooling and cooled
exhaust gas recirculation.
No Yes
Comments:
14 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 12 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:081 The tractor shall have tilt and telescoping steering column. No Yes
Comments:
03:082 Unit shall be equipped with self-canceling turn signals. No Yes
Comments:
03:083 The unit shall be equipped with a hazard switch. No Yes
Comments:
03:084 Unit shall have high output, fresh air type heater/defroster/air conditioner. No Yes
Comments:
03:085 All lighting shall be 12 volts. No Yes
Comments:
03:086 Instrumentation shall be centered and grouped in a logical manner to provide precise and
clear information quickly. No Yes
Comments:
03:087 Display to be easily read during full day light and night time operation. No Yes
Comments:
03:088
An hour meter that registers time only when the engine is running must be part of the
display and easily accessible by the driver or mounted to the steering column or below the
cup holder on the right-hand front corner post.
No Yes
Comments:
03:089 Included in display will be icon warning lights notifying driver of various operating
conditions. No Yes
Comments:
03:090 Tractor to have an electrohydraulic draft control load sense 3-point hitch with transport lock
external remote controls and a 6,475 Lb. (2937 kg) lift capacity. No Yes
Comments:
03:091
Tractor to be equipped with two (2) 7-way trailer connection plugs that conform to the
American Society of Agricultural and Biological Engineers (ASAE) and the Society of
Automotive Engineers (SAE) requirements and provide electrical power for wagons,
trailers, or other implement requirements.
No Yes
Comments:
03:092 Tractor shall have 3-pin electrical outlet sockets and power outlets provided near the right-
hand-side window with an additional outlet next to the Service ADVISOR data port. No Yes
Comments:
15 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 13 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:093 The 3-pin connectors shall include hot, or un-switched, and switched power and ground
connections. No Yes
Comments:
03:094
The 3-pin hot, or un-switched, power connectors shall be for maintaining monitor memory
when the tractor is shut off and is used where current drain is minimal when the tractor is
powered off.
No Yes
Comments:
03:095 Tractor shall be equipped with an under hood muffler. No Yes
Comments:
03:096 Hydraulics maximum operating pressure shall be at least 2,900 psi (20,000 kPa). No Yes
Comments:
03:097 Hitch sensing type shall be electronic lower link. No Yes
Comments:
03:098 Final drive shall be inboard planetary three pinion type. No Yes
Comments:
03:099 Differential controls shall be electrohydraulic. No Yes
Comments:
03:100 Rear differential lock shall be capable of being engaged on-the-go. No Yes
Comments:
03:101 Tractor shall have wet-disk hydraulic power brakes. No Yes
Comments:
03:102 Tractor shall have a wheelbase of 102 inches (2,580 mm). No Yes
Comments:
03:103 Front tread range shall be between 63.6 inches (1,616 mm) to 75.7 inches (1,924 mm). No Yes
Comments:
03:104 MFWD axle clearance shall be no less than 18.5 inches (469 mm). No Yes
Comments:
03:105 Tractor shall be able to connect to all John Deere 6130R (or equivalent) compatible
attachments without the need for any additional components. No Yes
Comments:
16 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 14 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
03:106 Spare parts shall be compatible with John Deere 6130R (or equivalent) parts. No Yes
Comments:
03:107 A complete operations, maintenance, and parts manual shall be provided as detailed in the
TRAINING AND MANUALS section. No Yes
Comments:
04: TRAINING AND MANUALS
When our operators and mechanics are thoroughly trained and knowledgeable about the unit, we get better performance and a
lower cost per operating hour, and you get a more satisfied customer.
Item Item Description Compliance
04:001 Upon delivery quoter shall provide a minimum of two days (a full 16 hours) of training at
the delivery location and annually as needed thereafter. No Yes
Comments:
04:002
Equipment training shall cover start up, routine maintenance services, diagnostics and
troubleshooting, safe and efficient operation, daily maintenance checks, storage, and overall
system familiarity.
No Yes
Comments:
04:003
The successful bidder shall provide the following product support information: two
complete sets of manuals (operators, parts, and service) including schematics, CAD
drawing, and desktop published photos for each component of the tractor. One set shall be
CD Rom version, and one set shall be standard hard copy.
No Yes
Comments:
04:004 If online parts catalog and ordering is available then it must be provided for the life of the
equipment with no additional cost to the Indianapolis Airport Authority. No Yes
Comments:
05: MISCELLANEOUS AND WARRANTIES
Item Item Description Compliance
05:001 All keys shall be provided in duplicate. No Yes
Comments:
05:002 A complete list of all replaceable filters cross referenced to Fleet Guard must be provided at
or before delivery of the unit. No Yes
Comments:
17 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 15 of 16 John Deere 6130R (or equivalent)
RFQ
Item Item Description Compliance
05:003 Only components or systems with a minimum guarantee, against defects in material and
workmanship, of one year may be quoted with this tractor. No Yes
Comments:
05:004 All batteries shall have no less than a 12 month simple FREE replacement warranty. State
warranty period. No Yes
Comments:
05:005 Tires shall be guaranteed against defects in material and workmanship for no less than 24
months. State warranty period. No Yes
Comments:
05:006 The tractor itself shall be guaranteed against defects in material and workmanship for a
minimum period of two years. State warranty period. No Yes
Comments:
05:007
The tractor and any of its components or systems with an original manufacturer’s standard
warranty lasting longer than the minimum required will carry the original manufacturer’s
standard warranty.
No Yes
Comments:
ADDITIONAL COMMENTS
It is the intent of this section to provide additional space to make comments. Entries in this section should follow the order of the
specifications and compliance form and be labeled with the original section title, number, and page of the item (e.g. 01: Compliance,
Item 01:003, Page 1: Additional comments). If additional space is needed the last page may be duplicated as required.
Type here if you have additional comments.
18 2016-005-Q-G
Indianapolis Airport Authority’s
Minimum Specifications and Compliance Form for a New 6130R John Deere (or
Equivalent) Cab Tractor with Loader Ready Package and Panorama Glass Roof
(2016) Cab Tractor Page 16 of 16 John Deere 6130R (or equivalent)
RFQ
19 2016-005-Q-G
INDIANAPOLIS AIRPORT AUTHORITY BUSINESS DIVERSITY PLANS
The contract goal for Indianapolis Airport Authority (IAA) solicitations is 15% Minority
participation, 10% Women participation and 3% Veteran participation, unless otherwise set
out in a solicitation. It is the intent of the IAA to meet or exceed the above mentioned
M/W/VBE goals. A responding vendor must submit, with its proposal, an Affidavit of Diverse
Vendor Utilization Plan (Schedule A and C) or a Diversity Program Waiver (Schedule B). The
Schedule A must show that there are, Minority Business Enterprises (MBE), Women Business
Enterprises (WBE), and/or Veterans Business Enterprises (VBE) that are certified by either the
City of Indianapolis, State of Indiana or Mid-States Minority Supplier Development Council
participating in the proposed contract. If participation is met through the use of vendors who
supply products and/or services directly to the Vendor (Subcontractor), the Vendor must
provide a description of the products and/or services along with the cost to provide, that are
directly related to this proposal. If used as a supplier, only 60% of the value of the supplies
can be counted toward achieving the M/W/VBE goal.
The IAA reserves the right to verify all information included on the Diverse Vendor Utilization
Plan.
Vendors must ensure that the proposed subcontractors meet the following criteria:
• Must be listed on the State of Indiana, City of Indianapolis or Mid-States Minority
Supplier Development Council’s Directory of Certified Firms.
• Each firm may only serve as one classification – MBE, WBE, or VBE
• A Vendor who is a MBE, WBE, or VBE can meet business diversity goals by using other
firms certified by either the State of Indiana, City of Indianapolis or the Mid-States
Council.
• Must serve a commercially useful function. The firm must serve a value-added purpose
on the engagement.
• Must provide goods or service only in the industry area for which it is certified as listed
in the directory of the State of Indiana, the City of Indianapolis or the Mid-States Council.
• Must be used to provide the goods or services specific to the contract.
• If used as a supplier, only 60% of the value of the supplies can be counted toward
achieving the M/W/VBE goal.
Schedule B: Application for Business Diversity Program Waiver is submitted when a vendor is
unable to meet the established goals. In such a case, the vendor must submit with the
Application for Waiver all documentation showing their good faith efforts to include MBE,
WBE, and VBE firms.
Vendors are encouraged to contact the IAA Supplier Diversity Department to develop business
diversity utilization plan to meet established goals.
SCHEDULE C: MBE/WBE/VBE Statement of Intent to Perform Work
A signed Schedule C from the MBE, WBE and/or VBE must be submitted prior to award of the
contract. Each Schedule C shall state and will serve as acknowledgement from the
subcontractor MBE, WBE and/or VBE of its subcontract amount and a description of products
and/or services to be provided on the project.
By submission of the quote/proposal/proposal, the Vendor acknowledges and agrees to be
bound by the regulatory processes involving the IAA’s M/W/VBE Program. Questions
involving the regulations governing the M/W/VBE Subcontractor Schedules should be directed
to:
IAA Supplier Diversity Department: supplierdiversity.ind.com | (317) 487-5374 |
20 2016-005-Q-G
Indianapolis Airport Authority
Schedule A: Affidavit of Diverse Vendor Utilization Plan
Prime Contractor/Proposer Name, Address, Telephone:
Project Name:
Project Number: Total Bid Dollar Amount: First Submission:
Revised Submission:
Affidavit of _________________________________________________,I do hereby certify that on the
_____________________________________________________ (Project Name), Project Number_____________, Amount of Bid
$_____________________, I will expend a minimum of ________% of the total dollar amount of the contract with certified
minority owned business enterprises (MBEs), a minimum of ________% of the total dollar amount of the contract with
certified woman owned business enterprises (WBEs), and a minimum of _______%of the total dollar amount of
contract with certified veteran owned business enterprises (VBEs). Project work will be contracted to the firms listed
below.
Name and Phone Number MBE/
WBE/VBE?
*Category Work Description Dollar Value
*MBE/WBE/VBE Categories: Female (F), African American (B), Hispanic (H), Asian American (A), American Indian (I),
Veteran (V).
Pursuant to the requirements of the Indianapolis Airport Authority Business Diversity Program, the undersigned will
enter into a formal agreement with MBEs, WBEs, VBEs for work listed in this schedule conditional upon execution of a
contract with the Owner. Failure to fulfill this commitment may constitute a breach of contract. The Undersigned
hereby certifies that he or she has read the terms of this commitment and is authorized to bind the proposer to the
commitment herein set forth.
Signature of Authorized Officer:
Printed Name of Authorized Officer:
Title:
Date:
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
21 2016-005-Q-G
Indianapolis Airport Authority
Schedule B: Application for Supplier Diversity Program Waiver
Bidder/Prime Contractor Name, Address, Telephone:
Project Name:
Project Number:
Total Bid Dollar Amount:
MBE/WBE/VBE Targets for this contract: _____%MBE _____%WBE _____%VBE
Percentages achieved to date: _____%MBE _____%WBE _____%VBE
Requesting a waiver of: _____%MBE _____%WBE _____%VBE
I have contacted the IAA Manager for assistance _______yes _______no
Number of MBE firms contacted: _________ (Attach list of names)
Number of WBE firms contacted: _________ (Attach list of names)
Number of VBE firms contacted: _________ (Attach list of names)
Attach documentation of your good faith efforts to secure, contact, and negotiate with MBEs, WBEs and
VBE’s, including:
1. The reasons your company is unable to secure sufficient MBE/WBE/VBE participation to meet the
stated goals.
2. The efforts made by your company to select portions of the contract to be performed by MBEs,
WBEs and VBEs.
3. For each MBE, WBE or VBE that placed a bid that you consider to be unacceptable, a statement that
explains the basis for that conclusion.
I hereby certify that ____________________________________, as bidder/prime contractor bidding on the
above named project; we have made good faith efforts as described in the attached documents to include
MBE/WBE/VBE companies in this project. Despite these efforts, we are unable to meet the stated goals or
targets and are therefore requesting a waiver as described above.
Signature of Authorized Officer:
Printed Name of Authorized Officer:
Title:
Date:
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
22 2016-005-Q-G
Schedule C: MBE/WBE Statement of Intent to Perform Work
MBE/WBE Name, Address, Telephone:
Prime Contractor Name, Address, Telephone:
Project Name:
Project
Number:
Total Bid Dollar Amount:
MBE/WBE Dollar Amount:
MBE/WBE % of Total Bid Amount:
Sole Proprietor____ Partnership____
Corporation____ Limited Liability Company____
Joint Venture____ Other________________
The above named certified DBE/MBE/WBE is (check all that applies):
Woman owned____ African American____
Hispanic____ Asian American____
American Indian____ Socially & Economically Disadvantaged____
The MBE/WBE/VBE status of the undersigned is confirmed by the attached letter of certification. The undersigned is
prepared to provide the following described services or supply the following described goods in connection with the
above-named project:
Sub-contracting levels (if not applicable, enter zero):
________% of the dollar value of this MBE/WBE/VBE subcontract will be sublet to non-MBE/WBE/VBE contractors.
________% of the dollar value of this MBE/WBE/VBE subcontract will be sublet to MBE/WBE/VBE contractors.
The undersigned subcontractor will enter into a contract with ________________________ for the work/service described
above upon the prime contractor’s execution of a contract with the Owner.
Signature of Authorized MBE/WBE/VBE Officer:
Printed Name of Authorized MBE/WBE/VBE Officer:
Title: Date:
I, the above bidder/prime contractor, agree to the terms and conditions stated above.
Signature of Authorized Bidder/Prime Contractor Officer:
Printed Name of Authorized Bidder/Prime Contractor Officer:
Title: Date:
23 2016-005-Q-G
NON-COLLUSION CERTIFICATION
This is to certify that the Respondent being duly affirmed under oath says, that he or she
is the contracting party or a duly authorized representative or agent for the Respondent;
that he or she has not, nor has any other employee of the company represented by him
or her, directly or indirectly, entered into or offered to enter into any combination,
collusion or agreement to receive or pay, and that he or she has not received or paid, any
sum of money or other consideration for the execution of the attached contract other than
that which appears upon the face of the contract.
SIGNATURE
This is to certify that the Respondent or any person authorized on behalf of the
Respondent has examined, understands and agrees to the specifications, including
General and Special conditions set forth in this document.
RESPONDENT ___________________________________________________
FEDERAL ID NUMBER ____________________________________________________
(Circle to indicate if your FIN is a TIN or SSN)
ADDRESS _______________________________________________________________
CITY ________________________ STATE____________ ZIP CODE _______________
TYPE OF BUSINESS (i.e. Corporate, Sole Proprietor, LLC, etc.)
________________________________________________________________________
TELEPONE NUMBER (____) _____________ FAX NUMBER (____) ______________
E-MAIL ADDRESS: _______________________________________________________
If awarded a contract, the Respondent will provide supplies, equipment, and/or services
in accordance with the general conditions, specifications, certifications, and other
documents contained within this solicitation.
I, _______________________________, the undersigned _______________________
(Signature of Officer) (Print Office Held)
of the above named bidder under penalties of perjury this _________day of ____________,
20____, certify that I hold the aforementioned Office in the above Bidder company and
that the representations are true and accurate.
24 2016-005-Q-G
TERMS AND CONDITIONS
1. ACKNOWLEDGEMENT: This Agreement contains the complete and final Agreement between the Indianapolis Airport Authority (IAA) and the Vendor/Contractor
and no other Agreement in any way modifying any of said Terms and Conditions will be binding upon the IAA or the Vendor/Contractor unless made in writing
and signed by the IAA’s and the Vendor/Contractor’s authorized representatives.
2. PRICING: Unit price must be entered and extended, and the total price of the solicitation must be shown. If there is an error between the unit price and total
price, the unit price shall prevail. Awarded Prices: Prices listed for each item are firm and cannot be changed. Any revision in price may be rejected at the
discretion of the IAA, and may result in cancellation of the Purchase Order without recourse on the part of the awarded Vendor/Contractor.
3. OPEN COMPETITION: The specifications contained herein are intended to be nonrestrictive. Although at times brand names and model numbers may be used,
they are merely intended to be guidelines to establish criteria and quality for competitive bidding. Alternate quotes/bids will be evaluated and may be
acceptable as long as they can be verified as equal to or better than specified as determined by the IAA. All offerors bidding alternate products are requested
to submit detailed specifications with their solicitation. Any Specifications, drawings, notes, instructions, engineering notices or technical data referred to in
the Solicitation/Purchase Order shall be deemed to be incorporated herein by reference as if fully set forth.
4. TERMINATION FOR CONVENIENCE: This Agreement may be terminated, in whole or in part, by the IAA whenever, for any reason, the IAA determines that such
termination is in the best interest of the IAA. Termination shall be affected by delivery to the Vendor/Contractor of a Termination Notice at least thirty (30)
days prior to the termination effective date, specifying the extent to which performance of services under which such termination becomes effective. The
Vendor/Contractor shall be compensated for performance prior to the notice date of termination but in no case, shall total payment made to the
Vendor/Contractor exceed the original Agreement price due on Agreement. No price increases shall be allowed on individual line items if canceled only in
part prior to the original termination date.
5. INSURANCE: If this Agreement provides for work to be performed by the Vendor/Contractor on property owned or controlled by the IAA, or on property of
others named herein, the Vendor/Contractor shall be responsible for providing all necessary unemployment, professional liabil ity and workers’ compensation
insurance for the Vendor/Contractor’s employees and liability and property/casualty insurance, as required by the IAA. Upon request, Vendor/Contractor shall
furnish a written Certificate of Insurance specifying the name of the Insurer, the policy, the expiration date and coverage acceptable to the IAA.
6. F.O.B. Destination: IAA solicitations are considered to be submitted on a delivered basis; therefore all solicitations will be considered to be made on the basis
of all shipping charges prepaid and allowed. If transportation charges are NOT allowed, the Vendor/Contractor must so state and show such charges in the
solicitation response. The shipment must be prepaid and transportation charges added to the invoice. The IAA will pay for such transportation charges only
on the basis of the lower price, whether it is the price shown in the solicitation response or the charges shown on the prepaid freight bill. THE IAA DOES NOT
HAVE FACILITIES FOR COLLECT SHIPMENTS; THEREFORE, COLLECT SHIPMENTS WILL NOT BE ACCEPTED.
7. DELIVERY: Delivery must be made at date/time agreed upon. If any indicated or actual delays arise, the using agency must be notified immediately by the
Vendor/Contractor, in writing, with the cause for such delay stated. If any goods are not delivered within the time specified on the Purchase Order, or within
a reasonable time not exceeding 30 days after receipt of a Purchase Order if no time is specified, the using agency may refuse to accept such goods, and this
Agreement may be cancelled. Each package shall be numbered and labeled with the IAA’s Purchase Order number, contents, and weight, and shall contain an
itemized packing slip and be properly packaged for shipment.
8. QUANTITY: Goods shipped in excess of quantity designated in the Purchase Order may be returned at the Vendor/Contractor’s expense.
9. COMPLIANCE WITH SPECIFICATIONS: The goods and/or services shall conform strictly to the specifications, drawings, or samples specified or furnished in
connection with the bid/quote, all of which are incorporated herein. The Vendor/Contractor warrants all goods and/or services delivered to be free from
defects of material or workmanship. This warranty shall survive any inspection, delivery, acceptance, or payment by the IAA of the goods and/or services.
Inspections shall be on the IAA’s premises unless otherwise specified. The IAA shall have the right to reject and return, at the Contractor’s expense, or to
require at the Contractor’s expense, the correction or replacement of materials, workmanship, or services which are defective or that do not conform to the
requirements of the Purchase Order.
10. TITLE: Title to all drawings, blueprints, dies, patterns, tools and all other property prepared or constructed by Vendor/Contractor at Vendor/Contractor’s plant
or elsewhere or ordered for use in connection with the order to the extent that IAA has made payment, therefore, or has furnished to Vendor/Contractor at no
charge, shall vest in and be the property of the IAA and shall be identified as such; and Vendor/Contractor assumes all liability for loss or failure to deliver
such property to the IAA.
11. WARRANTY: Contractor will furnish all parts and maintenance at no charge for a period of at least 90 days or the manufacturer’s stated warranty, whichever
is longer, provided that such maintenance and parts are not required because of an accident, neglect, misuse, or force majeure event. Contractor shall be
responsible for removal and/or disposal of all replaced parts. Prior to the expiration of the warranty period, whenever equipment is shipped for a mechanical
replacement purpose, the Contractor shall bear all cost of such shipment, including, but not limited to, cost of packaging, transportation, rigging drayage, and
insurance. All replacements shall be covered by a new warranty.
12. INTELLECTUAL PROPERTY DEFENSE: The Contractor shall, at its own expense, defend, indemnify, and hold harmless, the IAA with respect to any claims that
the goods and/or services furnished under this Agreement violates any third party intellectual property rights including, but not limited to, patents, copyrights,
trademarks and trade secrets.
13. PAYMENTS: All payments shall be made in arrears in conformance with IAA fiscal policies and procedures. No payments will be made in advance of receipt of
the goods or services that are the subject of this Agreement except as permitted by IC 4-13-2-20.
25 2016-005-Q-G
14. COMPLIANCE WITH LAWS: The Vendor/Contractor agrees to comply with all applicable federal, state, and local laws, rules, regulations, or ordinances, and all
provisions required thereby to be included herein are hereby incorporated by reference. The enactment of any state or federal statute or the promulgation of
regulations thereunder after execution of this Agreement shall be reviewed by the IAA and the Vendor/Contractor to determine whether the provisions of this
Agreement require formal modification.
15. NONDISCRIMINATION: Pursuant to IC 22-9-1-10 and Civil Rights Act of 1964, the Vendor/Contractor and its Agents, if any, shall not discriminate against any
employee or applicant for employment, to be employed in the performance of this Agreement, with respect to hire, tenure, terms, conditions or privileges of
employment or any matter directly or indirectly related to employment, because of race, religion, sex, disability, national origin, ancestry, or status as a veteran.
The Vendor/Contractor, and its subcontractor(s), if any, shall comply with all applicable affirmative action reporting requirements. Breach of this covenant
may be regarded as a material breach of this Agreement. The Vendor/Contractor shall comply with Section 202 of Executive Order 11246, as amended, 41
CFR 60-250, and 41 CFR 60-741, as amended.
16. TAXES: Prices listed on an invoice submitted by the Vendor/Contractor for payment is not to include any tax for which the IAA is exempt. The IAA will furnish
a tax exempt certificate, if requested by the Contractor. The IAA will not be responsible for any taxes levied on the Vendor/Contractor as a result of this
Agreement.
17. FORCE MAJEURE: In the event that either party is unable to perform any of its obligations under this Agreement, or to enjoy any of its benefits, because of
natural disaster or decrees of governmental bodies not the fault of the affected party (“Force Majeure Event”), the party who has been so affected shall
immediately give notice to the other party and shall do everything possible to resume performance. Upon receipt of such notice, all obligations under this
Agreement shall be immediately suspended. If the period of nonperformance exceeds thirty (30) days from the receipt of notice of the Force Majeure Event,
the party whose ability to perform has not been so affected may, by giving written notice, terminate this Agreement.
18. GOVERNING LAWS: This Agreement shall be construed in accordance with and governed by the laws of the State of Indiana and suit, if any, must be brought
in the State of Indiana.
26 2016-005-Q-G
7800 Col. H. Weir Cook Memorial Dr. Indianapolis, IN 46241 www.indianapolisairport.com 317.487.9594 office 317.487.5034 fax
***ACTION REQUIRED***
Attn: Accounts Receivable Department
Suppliers of the Indianapolis Airport Authority are required to complete the enclosed Survey A and Survey B. The Indianapolis Airport Authority will not be able to make purchases or pay any outstanding invoices from your company until the surveys are completed. Please email the completed surveys to [email protected] (preferred method). If email is not an option for your company, the completed surveys can be faxed to Courtney Kasper at 317-487-5201 or mailed to: Courtney Kasper Procurement Department Indianapolis Airport Authority 7800 Col. H. Weir Cook Memorial Drive Indianapolis IN 46241 Included for your reference is information about the Indianapolis Airport Authority. In the future, if the information submitted by your company changes (i.e. new company name, remittance address, ownership, certification, etc.) please email [email protected]. We will request a new Supplier Survey A and B to be completed to update our records. If you have any questions, please call Courtney Kasper at 317-487-5044. Thank you, Courtney Kasper Sourcing Buyer Enclosures
27 2016-005-Q-G
SUPPLIER SURVEY A Prepared for Indianapolis Airport Authority
Organization Name: _________________________________________________________________________ Mailing Street Address: ______________________________________________________________________ City: _________________________________ State: _______________Zip:________________ Location of Corporate Headquarters City: __________________________ State: ____ Zip: _______ Remittance Address (if different than Mailing Address above) Organization Name or Factor/Special Payee: _________________________________ Remittance Address: ________________________________________________________________________ City: ________________________________ State:_______________ Zip: ________________ Category of goods and/or services your organization supplies: ___________________________________________________ (See next page for a listing of category options) Organization Phone Number: (____)_______________________ Fax Number: (____)_______________________ Website Address: ______________________________________________ Ownership of your organization: A. Ethnicity and Gender – CHECK ALL THAT APPLY- See next page for definitions
___Woman Owned ___Asian American Owned ___African American Owned ___Hispanic Owned ___Native American or Alaskan Owned ___Other Owned (as described per definition #5 on the next page)
B. Type(s) of certification – CHECK ALL THAT APPLY - See next page for definitions ___MBE - Minority Business Enterprise ___VBE - Veteran Business Enterprise ___WBE - Woman Business Enterprise ___SBE - Small Business Enterprise ___DBE - Disadvantaged Business Enterprise Diverse Vendor Certification(s) and Membership(s) awarded to your organization – CHECK ALL THAT APPLY AND ENTER CERTIFICATION DATES FOR CITY AND STATE. SEND CERTIFICATIONS WITH COMPLETED FORM. ___City of Indianapolis Diverse Vendor Certification→ Start Date: ___/___/_____ End Date: ___/___/____ ___State of Indiana Diverse Vendor Certification → Start Date: ___/___/_____ End Date: ___/___/____ ___IMDSC – Indiana Minority Supplier Development Council ___HUsB – Historically Underutilized Small Businesses ___NAWBO – National Association of Woman Business Owners ___Other(s) please list: ____________________________________
If we have any questions about this completed survey, we should contact the following person at your organization: Name: ___________________________________ Title: ____________________________________ Phone Number: (____)______________________ ****Don’t forget Survey A and Survey B (W9 enclosed) must be completed and returned to the Indianpolis Airport Authority (IAA) before any payments can be made. In the future, if any of the information submitted changes contact IAA immediately. IAA will require a new supplier survey A and B to be completed in order to update our records.****
Email to [email protected] Form Updated: 04/22/201328 2016-005-Q-G
DEFINITIONS “Ethnicity” refers to individuals or groups who are citizens or lawful permanent residents of the United States and are of one or more of the following: 1. African-American (a person with origins in any of the black racial groups of Africa) 2. Asian-American (a person with the origins in any of the original peoples of the Far East, Southeast Asia,
the Indian Subcontinent or the Pacific Islands) 3. Hispanic (a person of Spanish culture with origins in Mexico, South or Central America, or Puerto Rico, or
Cuba or other Spanish origin, regardless of race) 4. Native-American or Alaskan Native 5. Members of other groups, or other individuals, found to be economically and socially disadvantaged by
the Small Business Administration under section 8(a) of the Small Business Act, as amended (15U.S.C 637(a))
“MBE - Minority Business Enterprise” is a sole proprietorship, partnership, corporation or joint venture of which a minimum of 51% is owned by one or more minorities. In the case of a proprietorship or partnership, the minority owner/s must be engaged in the daily management control and operation of the business concern. In the case of a corporation, minority stockholders must be in control of the management and daily business operations, and a majority of the directors must be of the following minority groups: African-American, Asian-American, Hispanic, Native American, Alaskan Native or members of other minority groups. “WBE - Woman Business Enterprise” is a sole proprietorship, partnership, corporation or joint venture of which women own a minimum of 51%. In the case of a proprietorship or partnership, the daily management and operation of the business concern is controlled by least one of the women who own the business. In the case of a corporation, women stockholders must be in control of the management and daily business operations, and a majority of the directors must be women. “DBE - Disadvantaged Business Enterprise” is a sole proprietorship, partnership, corporation or joint venture of which a person that is socially and economically disadvantaged owns a minimum of 51%. In the case of a proprietorship or partnership, the daily management and operation of the business concern is controlled by at least one of the socially and economically disadvantaged individuals who own the business. In the case of a corporation, socially and economically disadvantaged stockholders must be in control of the management and daily business operations, and a majority of the directors must be socially and economically disadvantaged. “VBE – Veteran Business Enterprise”: To be counted as a VBE with the Indianapolis Airport Authority firm must: Be registered with the U.S. Department of Veteran Affairs and Firm must submit letter from the US Department of Veteran Affairs to verify VA classification to the City of Indianapolis Department of Minority Business Development. Eligible Firms are: (a) Service Disabled Veteran and/or A Veteran; (b) A Small Business Concern; and (c) A Veteran-Owned Business or a (d) Service Disabled Veteran – Owned Business
(a) Service Disabled Veteran: A veteran who possesses a disability rating letter issued by the Department of Veterans Affairs, establishing a service-connected rating between 0 and 100% or a disability determination from the Department of Defense. The term ''service-connected'' means, with respect to disability or death, that such disability was incurred or aggravated, or that the death resulted from a disability incurred or aggravated, in line of duty in the active military, naval, or air service. [Title 38 Section 101 (16)]
(b) Small Business Concern: See SBA guidelines The term ''small business concern owned and controlled by veterans'' is defined as ''(A) not less than 51 percent of which is owned by one or more veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and (B) the management and daily business operations of which are controlled by one or more veterans.'' (A firm’s gross receipts must not exceed the industry size limits for the business.) [Title 15 Section 632(a)]
(c) Veteran-owned Business: Not less than 51% of which is owned by one or more veterans, or in the case of any publicly owned business, not less than 51% of the stock of which is owned by one or more veterans; and the management and daily business operations of which are controlled by one or more veterans The term ''veteran'' means a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable. [Title 38 Section 101 (2)]
(d) Service Disabled Veteran-Owned Business: Not less than 51% of which is owned by one or more service-disabled veterans, or in the case of any publicly owned business, not less than 51% of the stock of which is owned by one or more service-disabled veterans; and the management and daily business operations of which are controlled by one or more service-disabled veterans, or in the case of a veteran with a permanent and severe disability, a spouse or permanent caregiver of such veteran.
“SBE – Small Business Enterprise” See SBA guidelines
29 2016-005-Q-G
CATEGORIES OF GOODS AND SERVICES
Advertising Fencing Lumber Safety supplies/services
Aggregates Filters Mechanical/electrical Security
Alarm systems Fire extinguisher supply Office supplies/equipment Sewer inspection
Architecture Firearms/ammunition Paint and wall coverings Signs
Audio/visual equipment First aid supplies/equipment Pavement/grounds material Snow and ice supplies/service
Awards/engraving Floor covering Pest control Specialty items
Baggage conveyor Fuel - gasoline/oil/diesel Photographer Staffing agencies
Building materials General contractor Plumbing supplies/services Subscription
Carpet cleaning Glass supplies/repairs Printing Telecommunications
Catering services/food Government/State Professional service categories: 1. Business Develop/Marketing Tools
Chemicals Graphic design 2. Construction Services Training
Communications equipment Hotels/lodging 3. Engineering/Environment Trash removal/equipment
Computer hard/software HVAC- supplies/repairs 4. Finance/Accounting/Banking Travel agency
Concrete Insurance 5. Information Technology Trucking/transport
Conference Fee/Registration Interpreter 6. Legal Uniforms
Courier services Investment company 7. Real Estate Utilities
Door supplies/repairs Janitorial service/supply 8. Other Vehicle dealership
Electrical supplies Job Agency Professional organization Vehicle parts
Elevator/escalator Landscaping/mowing Recruitment Vehicle repair service
Entertainers Laundry Rentals/leasing Water conditioner/treatment
Erosion control Licenses Reporting Window cleaning
Excavation Lighting Roof supplies/repairs
30 2016-005-Q-G
Form W-9(Rev. December 2011)Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
Give Form to the requester. Do not send to the IRS.
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2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶
Other (see instructions) ▶
Exempt payee
Address (number, street, and apt. or suite no.)
City, state, and ZIP code
Requester’s name and address (optional)
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
Social security number
– –
Employer identification number
–
Part II CertificationUnder penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4.
Sign Here
Signature of U.S. person ▶ Date ▶
General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.
Purpose of FormA person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners’ share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income.
Cat. No. 10231X Form W-9 (Rev. 12-2011)31 2016-005-Q-G
Form W-9 (Rev. 12-2011) Page 2
The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases:
• The U.S. owner of a disregarded entity and not the entity,
• The U.S. grantor or other owner of a grantor trust and not the trust, and
• The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:
1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8.
What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Updating Your InformationYou must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies.
PenaltiesFailure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.
Specific InstructionsNameIf you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name.
If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form.
Sole proprietor. Enter your individual name as shown on your income tax return on the “Name” line. You may enter your business, trade, or “doing business as (DBA)” name on the “Business name/disregarded entity name” line.
Partnership, C Corporation, or S Corporation. Enter the entity's name on the “Name” line and any business, trade, or “doing business as (DBA) name” on the “Business name/disregarded entity name” line.
Disregarded entity. Enter the owner's name on the “Name” line. The name of the entity entered on the “Name” line should never be a disregarded entity. The name on the “Name” line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the “Name” line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the “Business name/disregarded entity name” line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8.
Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the “Name” line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate).
Limited Liability Company (LLC). If the person identified on the “Name” line is an LLC, check the “Limited liability company” box only and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter “P” for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for C corporation or “S” for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the “Name” line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the “Name” line.32 2016-005-Q-G
Form W-9 (Rev. 12-2011) Page 3
Other entities. Enter your business name as shown on required federal tax documents on the “Name” line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the “Business name/disregarded entity name” line.
Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the “Exempt payee” box in the line following the “Business name/disregarded entity name,” sign and date the form.
Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2),
2. The United States or any of its agencies or instrumentalities,
3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or
5. An international organization or any of its agencies or instrumentalities.
Other payees that may be exempt from backup withholding include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States,
9. A futures commission merchant registered with the Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under the Investment Company Act of 1940,
12. A common trust fund operated by a bank under section 584(a),
13. A financial institution,
14. A middleman known in the investment community as a nominee or custodian, or
15. A trust exempt from tax under section 664 or described in section 4947.
The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15.
IF the payment is for . . . THEN the payment is exempt for . . .
Interest and dividend payments All exempt payees except for 9
Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations.
Barter exchange transactions and patronage dividends
Exempt payees 1 through 5
Payments over $600 required to be reported and direct sales over $5,000 1
Generally, exempt payees 1 through 7 2
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.2 However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.
Part I. Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.
Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8.
Part II. CertificationTo establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the “Name” line must sign. Exempt payees, see Exempt Payee on page 3.
Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4.
1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.
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Form W-9 (Rev. 12-2011) Page 4
4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.
What Name and Number To Give the RequesterFor this type of account: Give name and SSN of:
1. Individual The individual2. Two or more individuals (joint
account)The actual owner of the account or, if combined funds, the first individual on the account 1
3. Custodian account of a minor (Uniform Gift to Minors Act)
The minor 2
4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law
The grantor-trustee 1
The actual owner 1
5. Sole proprietorship or disregarded entity owned by an individual
The owner 3
6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A))
The grantor*
For this type of account: Give name and EIN of:
7. Disregarded entity not owned by an individual
The owner
8. A valid trust, estate, or pension trust Legal entity 4
9. Corporation or LLC electing corporate status on Form 8832 or Form 2553
The corporation
10. Association, club, religious, charitable, educational, or other tax-exempt organization
The organization
11. Partnership or multi-member LLC The partnership12. A broker or registered nominee The broker or nominee
13. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments
The public entity
14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B))
The trust
1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name and you may also enter your business or “DBA” name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 1.
*Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.
Secure Your Tax Records from Identity TheftIdentity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance.
Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: [email protected] or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
Privacy Act NoticeSection 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
34 2016-005-Q-G
Information Sheet
For
Indianapolis Airport Authority 7800 Col. H. Weir Cook Memorial Drive
Indianapolis, Indiana 46241-4941
Phone Number: 317.487.9594 Fax Number: 317.487.5201
Tax Information Taxpayer ID: 35-1065397 Indiana Sales Tax Information Exemption Number: 0101743807-001
Addresses: Billing Address: Attn: Accounts Payable Indianapolis Airport Authority
7800 Col H. Weir Cook Memorial Drive Indianapolis, IN 46241-4941 Delivery Address: Attn: Receiving Department Indianapolis Airport Authority 2000 South Banner Avenue Indianapolis, IN 46241 Contacts: Angie Tromp – Accounts Payable Supervisor
Stacy Stevenson – Accounts Payable [email protected]
Holli Harrington - Diversity Director Phone 317.487.5374 Fax 317.487.5034 Email [email protected]
Additional Information:
Payment Terms: Net 30 Purchase Order Number: Required on all Invoices and Packing Slips
35 2016-005-Q-G