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SBTDOT-3logo-2010-dept--of-transportatio

Shoshone-Bannock Tribes

TRANSPORTATION
D E P A R T M E N T

ICA - Packet upload form

Contractor

Address

Department #

Manager

Line Item Number:

Contract Amount

Note: If cost-sharing input additional line items and amount to be taken from it.

Additional Line Item 2

Contract Amount

Additional Line Item 3

Contract Amount

Additional Line Items Cont.

Supporting Documentation Uploads

Is this a sole source ICA

Yes

No

Is this an emergency?

Yes

No

Will a 3rd Party Contract be included?

Yes

No

ICA Template Word Document only

Upload File

Upload supported file (Max 15MB)

3rd Party Contract/Agreement (If ICA template is not to be used)

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Signed W-9 (PDF)

Upload File

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Business License

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Workers Comp/Exemption Cert.

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EPLS Search

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RFP (PDF)

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Completed Bidders List

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Completed Contractor's Bid Submission Sheet

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Written sole source justification

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Excutive Director/FHBC Approval

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Contractor's Quote(s)

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Additional Comments

Thanks for submitting!

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