115350R1piggybackform

							State Procurement Manual                                                            Number PRO-D-29
                                                                                   Effective 5-1-92
                                                                                            Page 1A



                                         PIGGYBACKING DATA FORM


ORIGINATING AGENCY: UW-Madison

ORIGINATING PURCHASING AGENT: Susanne Matschull TELEPHONE NUMBER: 608-262-3198

COMMODITY/SERVICE: Glass Vacuum Tubes

COMMODITY CODE: 175-42, 475-95, 490-43

BRIEF DESCRIPTION OF CONTRACT:
Contract for Blood Collecting Glass Vacuum Tubes for Blood Alcohol Tests.

CONTRACT EFFECTIVE DATES: June 1, 2011 through May 31, 2012 RENEWAL OPTIONS: 2 Years

RFB NUMBER: 11-5350-R1 RFB OPENING DATE: May 9, 2011

NUMBER OF BIDS RECEIVED: 1      DATE OF AWARD: May 19, 2011

WERE THERE ANY PROTESTS? _X__NO

LIST ALL VENDORS ON CONTRACT INCLUDING FEDERAL EMPLOYER IDENTIFICATION NUMBERS, ADDRESSES
AND TELEPHONE NUMBERS:

VENDOR                                              FEIN #                  PHONE #

TRI-TECH FORENSICS INC                              26-3669072              910-457-6600
4019 EXECUTIVE PARK BLVD SE
SOUTHPORT NC 28461