City of Brockton, Massachusetts
Date:
Chapter 30B Quote Form
($10,000 to $50,000) Chp. 30b (Goods & Services)
*written contract required for all procurements over $10,000
Department: Contact Name:
1) Type of Supplies and/or Services to be Purchased: Purpose of Use:
_____________________________________________________________________________
2) Is this an Emergency Procurement/or Sole Source (
Under $50,000
)? Yes OR No If so, why?
____________________________________________________________________________
3) Quotations Solicited From:
A. Company Name:
Address:
City/State/Zip Code:
Contact Person:
E-mail:
Quote: $ _
Date: _
Phone:
Title: _
B. Company Name:
Address:
City/State/Zip Code:
Contact Person:
E-mail:
Quote: $ ____________ __
Date: _
Phone:
Title: __________________
C. Company Name:
Address:
City/State/Zip Code:
Contact Person:
E-mail:
Quote: $ ____________
Date: _
Phone:
Title:___________________
Please send correspondence to: Procurement@cobma.us
Authorized by:
Department Head's Signature /Date Approved by: Michael C. Morris/Date
Chief Procurement Officer
For Procurement use only:
Contract/Project #:
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