MCCI of Indiana, LLC Lincolnshire, IL 60069

1 00 1010 MCCI of indiana , LLC lincolnshire Place Memory Care Facility Bidder s Checklist - Page 1 MCCI of indiana , LLC 175 Olde Half Day Road, Suite 292 lincolnshire , IL 60069 lincolnshire Place Memory Care Center Fort Wayne, IN BIDDER S CHECKLIST To be considered for the project, please verify all requirements are met: Contact Tyson and Billy Architects to register for website PDF document access Bid Form, signed and notorized with all Addenda acknowledged A Bid Bond or Certified Check in the amount of ten percent (10%) of the Base Bid Proposal Completed AIA form A305, contractor qualifications MCCI of indiana , LLC 175 Olde Half Day Road, Suite 292 lincolnshire , IL 60069 BID FORM TO: MCCI of indiana , LLC FROM: _____ NAME OF BIDDER _____ STREET ADDRESS _____ CITY STATE ZIP _____ PHONE FOR.

2 MCCI of indiana , LLC lincolnshire Place Memory Care Center, Fort Wayne, indiana GENERAL ACKNOWLEDGMENT The undersigned, having carefully examined the Contract Documents, all data made available, having visited the site of work and having become fully informed as to all existent conditions and limitations, including the obstacles which may be encountered, local restrictions, and all other relevant matters concerning the Work to be performed, hereby propose to perform everything required to be performed, and to provide all the labor, materials, necessary tools, expendable equipment, all applicable taxes and fees and bonds, and provide all utility and transportation services necessary to perform and complete in a workmanlike manner the entire work in conjunction with the: MCCI of indiana , LLC lincolnshire Place Memory Care Center, Fort Wayne, indiana in accordance with the Contract Documents as prepared by Tyson and Billy Architects, ; including Addenda Number _____, _____, _____, _____, _____, issued thereto as follows: Addendum No.

3 _____ Date: _____ Addendum No. _____ Date: _____ Addendum No. _____ Date: _____ Addendum No. _____ Date: _____ Addendum No. _____ Date: _____ 00 4100 MCCI of indiana , LLC lincolnshire Place Memory Care Facility Bid Form - Page 2 AGREEMENT In submitting this Bid, the undersigned agrees to hold this Bid open for sixty (60) days from submittal date; to enter into and execute a Contract with the Owner, within ten (10) working days after receiving Bid Award; to accomplish the work in accordance with the Contract Documents, and to complete the work by the time stipulated in the Agreement. In submitting this Bid, it is understood that the right is reserved by the Owner to reject any and / or all bids and to waive any informalities in bidding. LUMP SUM BASE BID _____ $_____ (Words) (Numerals) ALTERNATE BIDS ALTERNATE BID #1 Provide Epoxy Flooring and cove base in 303,304,306,307 [Add] [Deduct] _____ $_____ (Words) (Numerals) ALTERNATE BID #2 Provide fiber cement siding in lieu of vinyl siding [Add] [Deduct] _____ $_____ (Words) (Numerals) ALTERNATE BID #3 Provide luminaires, exit lighting, and emergency lighting (less barber pole and theater ticket boot lights) [Add] [Deduct] _____ $_____ (Words) (Numerals) ALTERNATE BID #4 Provide tile floors, cove base, and walls in unit bathrooms [Add] [Deduct] _____ $_____ (Words) (Numerals) ALTERNATE BID #5 Provide Vinyl Handrail system at interior rail HR-1 in lieu of painted wood [Add] [Deduct] _____ $_____ (Words) (Numerals)

4 00 4100 MCCI of indiana , LLC lincolnshire Place Memory Care Facility Bid Form - Page 3 SIGNATURE Signed this_____day of_____ 2015. _____ Full Name of Bidder ( Print ) (a) Individual ( ) (b) Partnership ( ) (c) Corporation ( ) _____ Full Name of Bidder ( Signature ) _____ Official Title _____ ( Seal )

5 Street Address If the Bidder is a Corporation, the Bidder will attach a notarized and verified document establishing that the signator has authority to execute the Bid Form on behalf of the Corporation. NOTARIZATION SUBSCRIBED AND SWORN TO: before me this day of 2015. NOTARY PUBLIC END OF BID FORM