Public Notice Advertisement for Bids

Similar documents
ATTACHMENT NO. 1 BIDDER S PROPOSAL ACKNOWLEDGEMENT

EXHIBIT VIII-N PERFORMANCE AND PAYMENT BONDING REQUIREMENTS

QUOTE DOCUMENTS FOR CALLANAN GYM FLOOR REPLACEMENT center Street. Des Moines, Iowa QUOTE # Q7088

QUOTE DOCUMENTS FOR KING PARKING EXPANSION Forest Avenue. Des Moines, Iowa QUOTE # Q6747. Owner

WEST BOYLSTON MUNICIPAL LIGHTING PLANT 4 Crescent Street, West Boylston, Massachusetts Telephone (508) Fax (508)

5.; <. (3. ; 5 )$ )!!,5. 2*3 = ( ; ;. ( 5

CONTRACT DOCUMENTS AND SPECIFICATIONS STREET SWEEPING

Sunnyside Valley Irrigation District

CONTRACT. This agreement, made and entered into this day of, 2013, in Reno, Nevada, by and between the City of Reno, hereinafter called the City, and

PERFORMANCE BOND. Surety Bond No. STATE OF TEXAS KNOW ALL MEN BY THESE PRESENTS: COUNTY OF

Cherokee County Board of Commissioners

BID: Escanaba WWTP Digester Roof Restoration

EXHIBIT F-1 (I) FORM OF DESIGN-BUILD LETTER OF CREDIT VIRGINIA DEPARTMENT OF TRANSPORTATION 1401 EAST BROAD STREET RICHMOND, VA ATTN: [ ]

September 16, 2016 CCTA Contract No. 427 Caltrans Contract No. 04-4H1604 Balfour Interchange Project

UNIVERSITY OF KENTUCKY CAPITAL CONSTRUCTION PROCUREMENT SECTION PAYMENT BOND

RULES OF DEPARTMENT OF REVENUE VEHICLE SERVICES DIVISION CHAPTER TITLE BONDS TABLE OF CONTENTS

Invitation to Bid. FUNDING: The project shall be funded entirely with County funds, and shall be governed by strict guidelines for use of funds.

Yurok Tribe Planning and Community Development Klamath, California. Yurok Justice Center Bid Documents EXHIBIT B: BID FORM

CITY OF RICHMOND PERFORMANCE BOND

ON-CALL EMERGENCY CONSTRUCTION CONTRACT AGREEMENT IN THE CITY OF CALABASAS, CALIFORNIA

CONTRACT AND BOND FORMS FOR

LAND IMPROVEMENT AGREEMENT

EXHIBIT WARRANTY BOND. (Address), hereinafter called Principal, and

CONTRACT FORM CONTRACT #

LINCOLN UNIFIED SCHOOL DISTRICT CHROMEBOOK BID

McCRACKEN COUNTY BOARD OF EDUCATION

ARLINGTON HEIGHTS PARK DISTRICT INVITATION FOR QUOTES

Bid Addendum #1 Bid # 13/14-01FA: Furniture and Equipment Bid Issued March 19, 2014

OHIO DEPARTMENT OF TRANSPORTATION

BOND FOR FAITHFUL PERFORMANCE

REQUEST FOR PROPOSALS For the Installation and Maintenance of a Backup and Disaster Recovery System

Proposal for Bidding Purposes

LAKE METROPARKS SPEAR ROAD CONCORD TWP., OHIO THE PRINTING OF LAKE METROPARKS PARKS PLUS! QUARTERLY PUBLICATION BID #

Invitation for Informal Bid (IFIB) Summary. 3. Exhibit A Proposal / Bid Forms.. 7. Agreement. 12. Payment Bond 14. Performance Bond 17

BOND FOR FAITHFUL PERFORMANCE

Electronic Distribution Only Not For Bidding Purposes

C. Public-private partnership construction contracts. (a) Definitions for purposes of this section: (1) Construction contract.

ABC UNIFIED SCHOOL DISTRICT Notice Calling for Bids ABC-1325 E-Rate Equipment INSTRUCTIONS FOR BIDDERS

EXHIBIT CONSTRUCTION CONTRACT BOND

ALABAMA A&M UNIVERSITY Carter and Chambers Fire Alarm System(s) A. Project Identification: New Fire Alarm system(s) Carter/Chambers

AUTOMOTIVE STORAGE FACILITY BID F-460 Bid Deadline September 15, 2:00 p.m.

PUBLIC WORKS DEPARTMENT DELLA STREET SANITARY SEWER REHABILITATION PROJECT NO. M17025

FORM OF AGREEMENT BETWEEN CONSTRUCTOR AND OWNER

PROPOSAL & CONTRACT (THIS PROPOSAL INCLUDES (WHEN EXECUTED)

TO ALL PROSPECTIVE BIDDERS:

INVITATION TO BID. 3. All bids submitted will be considered firm for a period of 60 days from the bid opening date.

FINAL RELEASE OF CONSTRUCTION LIEN RIGHTS

CITY OF PETALUMA. POST OFFICE Box 61 PETALUMA, CA ADDENDUM NO. 1. AIRPORT PREVENTIVE MAINTENANCE RAMP CRACK SEAL City Project No.

Bond No. GAS AND OIL DRILLING AND OPERATING BLANKET SURETY BOND KNOW ALL MEN BY THESE PRESENTS, THAT THE UNDERSIGNED. , Name of Corporation Permittee)

FIRST INDEMNITY OF AMERICA INSURANCE COMPANY INDEMNITY AGREEMENT

BID FORM EAST LINCOLN COUNTY SEWER IMPROVEMENTS WSP # I

CERTIFICATE. Final. Upon. Instructions: letterhead. Page 1 of 3. CDC Documents. Revised 1/22/2018

SOURCE ONE SURETY, LLC.

ATTACHMENT B: SAMPLE CONTRACT (AGREEMENT)

NOTIFICATION OF ADDENDUM ADDENDUM NO. 2 DATED 11/05/2018

SOLICITATION # EATONTON-PUTNAM SENIOR CITIZEN CENTER CONGREGATE MEALS PROGRAM

CITY OF DOUGLAS Contract Documents & Specifications for a New Specified Reel Grinder Douglas Community Club (Golf Course)

Contract for St. Johns County School Board Osceola Elementary School Classroom Expansion

Carpet Replacement Project Des Peres Department of Public Safety

REQUEST FOR BID. Bid Number Softball Field Netting Barrier Orange Coast College

Termination for Default,

00400 BID FORMS AND SUPPLEMENTS

Tiffany Strine SECRETARY Sealed Proposals will be received on or before 8:30 A.M. on the above Letting Date West Canal Road TIME

TOWN OF QUEENSBURY PURCHASE OF A NEW KIOTI TRACTOR FOR USE BY THE QUEENSBURY CEMETERY DEPARTMENT BID DOCUMENTS

CITY OF NORTH LAS VEGAS BID PROPOSAL., (hereinafter called Bidder)* a *, organized and existing under the laws of the State of

The Arlington Heights Park District reserves the right to waive any informality in the quotes received according to its own judgment.

F O R M OF P R O P O S A L

AGREEMENT 4 pages. SPECIFICATION 1 page. LABOR & MATERIALS 4 pages. PERFORMANCE BOND 4 pages

CITY OF GAINESVILLE REQUEST FOR PROPOSAL

LEGAL AD. Invitation to Bid Bid No For the purchase of 1 new Motor Grader

REQUEST FOR QUALIFICATIONS FOR PEER REVIEW AND ON-CALL CONSULTING ENGINEER SERVICES FOR PLANNING & DEVELOPMENT

SUBDIVISION IMPROVEMENT AGREEMENT. (Date of Subdivision Map Recordation: )

ROCK SALT FOR ICE CONTROL

Proposal must provide warranty for all material and construction. See the specifications on the building.

REQUEST FOR BIDS FOR AUTOMOTIVE EQUIPMENT RFB # AVC2016/

CAMBRIA/INDIANA SCHOOLS JOINT FUEL PURCHASING CONSORTIUM. c/o PENN CAMBRIA SCHOOL DISTRICT 201 6th Street, Cresson, Pennsylvania 16630

CONTRACT DOCUMENTS SPECIFICATIONS. for RAILROAD AVE. AND MAIN STREET TRAFFIC SIGNAL UPGRADE CITY OF FORT MORGAN, COLORADO.

STANDARD BID & SPECIFICATIONS PACKAGE

PUBLIC WORKS DEPARTMENT POLICE DEPARTMENT UNDER FREEWAY PARKING LOT IMPROVEMENTS PROJECT NO. PW1621

THE CITY OF BRENTWOOD 2348 Brentwood Blvd. Brentwood, MO REQUEST FOR PROPOSAL FOR ROLL OFF DUMPSTER SERVICES

THIS CONTRACT is executed as of this day of, 2017, effective as of October 1, 2017 (the Effective Date ), by and between the CITY OF

Electronic Distribution Only

SPECIFICATIONS. Autoclave/Sterilizer FOR. Lake Land College District Number 517 Mattoon, Illinois PROJECT NO Bid Date; May 22, 2018

CITY OF FREDERICK, MARYLAND PERFORMANCE BOND

CITY OF OLATHE. Please type or print. PROPERTY OWNER NAME (PERMIT HOLDER): OWNER AGENT: ADDRESS: CITY: STATE: ZIP:

REQUEST FOR PROPOSALS RFP SEASONAL ARTIFICIAL ICE SKATING RINK

CITY OF SIKESTON INVITATION FOR BID GENERAL REQUIREMENTS

ITB-PW Concrete psi with Fiber Mesh. Required Submittals

Proposal for Bidding Purposes

San Francisco Unified School District CUPCCAA PROJECT <$45K - $175K>

CITY OF SIKESTON INVITATION FOR BID GENERAL REQUIREMENTS

Subcontractor's Application for Payment (K201)

Part VIII Material and Construction Specifications

Alaska Railroad Corporation

TABLE OF CONTENTS DEFINITION NOTICE INVITING BIDS INSTRUCTIONS TO BIDDERS PROPOSAL BID PROPOSAL Part 1 NON-COLLUSION AFFIDAVIT Part 1 UNIT PRICE LIST

RECEIVED AT WHICH TIME BIDS

Newark Unified School District 5715 Musick Ave., Newark, California Telephone (510) ; FAX (510)

City of Los Alamitos

BOND INSTRUCTIONS 1. IF THE PRINCIPAL IS AN INDIVIDUAL OR PARTNERSHIP:

LEGAL NOTICE - ADVERTISEMENT FOR BID

Transcription:

Public Notice Advertisement for Bids Sealed bids for the purchase of multiple self-contained breathing apparatus (SCBA) and related equipment for the Fire Department will be received by the City of Bucyrus Safety Service Director s Office, 500 S. Sandusky Ave., Bucyrus, Ohio, until 1:00pm, December 28, 2018, at which time bids will be publicly opened and read aloud. The Bidding Documents, which include Specifications and Bid Form, may be obtained at the City of Bucyrus Safety Service Director s Office, 500 S. Sandusky Ave., Bucyrus, Ohio, at no cost. A copy of the documents can be also be downloaded from our website at http://www.cityofbucyrusoh.us. Bids must be signed and submitted on City bid forms included in the bid package. The sealed envelope shall be marked Bucyrus SCBA Bid. Each bid shall contain the full name of the party or parties submitting the Bid and all persons interested therein. No Bidder shall withdraw his Bid after the actual opening thereof. This procurement is to be funded in part with federal funds through the FY17 Assistance to Firefighters Grant (AFG) through FEMA. All bidders shall be held to specific federal conditions of this purchasing process, which is outlined in the bidding documents. The City reserves the right to reject any or all Bids, waive irregularities in any Bid, and to accept any Bid that is deemed by City to be in the best interest of the City. Jeffery Wagner, Safety Service Director Publication Date: December 10, 2018 December 17, 2018

Minimum Specifications Required by the City of Bucyrus / Bucyrus Fire Department for the purchase of Self-Contained Breathing Apparatus and Related Equipment All bids must be received at the City of Bucyrus, Safety Service Director s Office City of Bucyrus 500 S. Sandusky Ave. Bucyrus, OH 44820 All envelopes must be clearly marked: Bucyrus SCBA Bid All bids must be received no later than: December 28, 2018 at 1:00 p.m.

Intent of specifications: The City of Bucyrus Fire Department is seeking bids for the following: Amount Description 18 SCBA 18 Mask (Face piece) with voice amplification 36 Compressed Air Cylinder (Air Bottle) Bid Format: Bids must be printed by computer for legibility. Signature on bids: Bids must be signed in ink by an authorized representative of the bidder. Signature on a bid certifies that the bidder has read and fully understands all bid specifications, terms, and conditions. Bid Withdrawals: Bids may be withdrawn in writing on company letterhead and signed by an authorized representative. Letters of withdrawal must be received at the Bucyrus Fire Department prior to bid deadline. Bids may also be withdrawn in person before bid closing upon presentation of appropriate identification. Exceptions: These specifications are based upon design and performance criteria which have been researched and analyzed by the Bucyrus Fire Department. Therefore, major exceptions to these required specifications will not be accepted. Exceptions to preferred specifications will still be considered. All bids shall include a complete set of detailed manufacturer s specifications. Standards for bidding must be adhered to strictly and all bid forms and questions must be complete and submitted with the bid proposal. Omissions and variations shall result in rejection of the bid. To the right side of each statement of a particular specification, the bidder shall indicate Yes or No to indicate whether or not their proposed product meets that specification. All deviations, no matter how slight, must be clearly explained. Every exception or variation to the specifications set forth in this bid document must indicate the letter(s) and number(s) of the specification(s) and must be submitted with the bid. Any bids deemed as taking total exception to these published specifications shall result in rejection of the bid. Proposals that are found to have deviations that are not listed will be rejected. Any product that is bid must have current NIOSH and NFPA approval at the time of the bid opening. Any product that is not approved but is bid will be grounds for rejection of that bid. There must be no attempt on the part of the bidder to mislead or confuse the fire department with the equipment that is being bid.

Warranties: Unless otherwise stated, all equipment shall be new manufacture (not previously used) and shall carry full factory warranties. The bid contractor warrants all equipment and supplies delivered to be free from defects in labor, material, and manufacture and to be in compliance with the warranty stipulated in the bid specifications. Service and warranty support: To ensure full dealer support for service after the sale, the selling dealer must be capable of providing full factory service when required. The bidder must state the location of its authorized service center. The service center must have a staff of factory recognized personnel and be located within 150 miles of Bucyrus, Ohio. Delivery: All deliveries shall be to the City of Bucyrus Fire Department, with all transportation and handling charges prepaid by the bidder. Responsibility and liability for loss or damage shall remain with the bidder until final inspection and acceptance by the Bucyrus Fire Department, at which point responsibility shall pass to the Bucyrus Fire Department with the exception of latent defects, fraud, and manufacturer s warranty obligations. Before delivering the SCBA to the fire department, a function test shall be performed on each SCBA. This shall be a complete function test as required by CFR 29 1910.134. This is to ensure the SCBA are in complete working order when delivered. Upon delivery, a copy of the computergenerated report shall be provided with each unit to verify that each unit has been tested. All battery-powered equipment shall be delivered with sufficient batteries included to operate that unit, whether alkaline or rechargeable. The bid shall include certification documents that verify the units bid meet the current NIOSH and NFPA standards. In order to be considered for purchase, the equipment the bidder is providing pricing for must have existing NIOSH and NFPA approvals and documentation of those approvals must accompany the bid documents or the bid for that equipment will be considered invalid. The only exception to this would be that an upgrade to bring the units up to the 2018 version is included in the bid.

Required Specifications: Product meets bid spec. A: SCBA- 1: 4500 PSI system Yes No 2: Swiveling/Pivoting Hip belt Yes No 3: Chest Strap Yes No 4: Harness straps removable without tools for easy decontamination Yes No 5: Quick connect/disconnect cylinder connection (Snap change) Yes No 6: Electronic Voice Amplification (may be mask mounted) Yes No 7: Shoulder strap mounted analog gauge Yes No B: Cylinder- 1: DOT certified, 15 year service life Yes No 2: 4500 PSI working pressure Yes No 3: 45 minute (1800 liter) capacity Yes No 4: Carbon Fiber construction Yes No 5: Quick connect capable (with or without adapter) Yes No 6: Cylinders delivered within three months of manufacture date Yes No C: Face piece- 1: Available in multiple sizes Yes No 2: The lens shall have anti-fog coating inside or have anti-fog wipe Yes No Included with face piece 3: Electronic voice amplifier (if not integrated with SCBA) shall be Yes No Removable without tools for easy cleaning 4: The head harness shall be either four-point or five-point adjustment Yes No Head net, which will be chosen by the individual to whom it is issued 5: Removable neck strap Yes No 6: Fleece-lined storage bag to protect the face piece Yes

No Required Specifications: (continued) Product meets bid spec. D: Services- 1: Initial fit testing for 16 fire department members Yes No 2: In-service training for three crews to be provided on-duty Yes No 3: Upgrade of SCBA s to 2018 version of NFPA standards 1981 and 1982 Yes No Once the standards are implemented E: Station Equipment- 1: Fittings to convert our fill station to fill quick connect cylinders Yes No (If required to fill cylinders without using tools) Preferred Specifications: SCBA- Hip belt with adjustable lumbar height to accommodate different sized Yes No Firefighters Electronic voice amplifier that mutes inhalation noise Yes No Control module that provides estimated time to empty Yes No Single battery power source Yes No Optional Items: (will be priced separately) SCBA- Rechargeable battery RIT Unit- RIT Unit with bag Station Equipment- Battery charger This form must be completed for the bid to be accepted. If not completed, the bid will be considered non-responsive and not considered. Manufacturer: SCBA Model: Total Bid Price of following: 18 SCBA 18 Face piece (With electronic voice amp if not built-in to SCBA) 36 Cylinder (With quick connect capability) 2 Quick-Connect fittings for fill station (if needed)

Optional pricing: (By quantity stated) Rechargeable battery packs x1 Battery charger x1 RIT Unit with bag x1 Additional Face pieces x1 Bidder Name (Company): Person submitting bid: Signature: Bidder Address: Bidder phone number: Exceptions to required specifications: (List by letter and number)

(TO BE RETURNED WITH BID) FORM OF NON-COLLUSION AFFIDAVIT State of Ohio ) ) County of ) Bid Identification: Contractor:, being first duly Sworn, deposes and says that he/she is (Sole owner, a partner, president, secretary, etc.) of, the party making the foregoing bid; that such bid is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation; that such bid is genuine and not collusive or sham; that said bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that any one shall refrain from bidding; that said bidder has not in any manner, directly or indirectly, sought by agreement, communication or conference with anyone to fix the bid price of said bidder or of any other bidder, or to fix any overhead, profit, or cost element of such bid price, or of that of any other bidder, or to secure any advantage against the public body awarding the contract or anyone interested in the proposed contract; that all statements contained in such bid are true; and further, that said bidder has not, directly or indirectly, submitted his bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any other individual except to such person or persons as have a partnership or other financial interest with said bidder in his general business. Signed Title Subscribed and sworn to before me this day of, 2018. Notary Public SEAL

PERFORMANCE-PAYMENT BOND KNOW ALL MEN BY THESE PRESENTS: That we (1) a (2), Hereinafter called Principal and (3) Of, State of hereinafter Called the Surety, are held and firmly bound unto (4), hereinafter called Owner in the penal sum of Dollars ($ ) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain Contract with the Owner, dated the day of, 20, a copy of which is hereto attached and made a part hereof for the furnishing of: NOW, THEREFORE, if the Principal shall well, truly and faithfully perform its duties, all the undertakings, covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions thereof which may be granted by the Owner, with or without notice to the Surety, and if he shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and save harmless the Owner from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the Owner all outlay and expense which the Owner may incur in making good any default and shall promptly make payment to all persons, firms, subcontractors, and corporations furnishing materials for or performing labor in the prosecution of the contract, and any authorized extension or modification thereof, including all amounts due for materials, lubricants, oil, gasoline, repairs on machinery, equipment, and tools, consumed or used in connection with the construction of such equipment, and all insurance premiums on said work, and for all labor, performed on such work whether by subcontractor or otherwise, then this obligation shall be void, otherwise to remain in full force and effect. PROVIDED, FURTHER, that the said Surety, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to the work to be performed thereunder or the specifications accompanying the same shall in any wise affect its obligation on this bond, and it does hereby waive notice of any such change, extension of time, alteration or addition to the terms of the contract or to the work or to the specifications.

PERFORMANCE PAYMENT BOND - (Continued) PROVIDED, FURTHER, that no final settlement between the Owner and the Contractor shall abridge the right of any beneficiary hereunder, whose claim may be unsatisfied. IN WITNESS WHEREOF, this instrument is executed in ( ) counter-parts, each of which shall be deemed an original, this the day of 20. SEAL (Principal) Secretary Principal By Address Witness as to Principal Address ATTEST: Surety Surety Secretary by ATTORNEY-in-FACT SEAL Address Witness as to Surety Address NOTE: Date of Bond must not be prior to date of Contract. (1) Correct Name of Contractor (2) A Corporation, a Partnership or an Individual, as case may be (3) Correct Name of Surety (4) Correct Name of Owner (5) If Contractor is Partnership, all Partners should execute bond.

BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, as Principal, and as Surety, are hereby held and firmly bound unto as Owner in the penal sum of for payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns. Signed this day of, 20. The condition of the above obligation is such that whereas the Principal has submitted to a certain bid, attached hereto and hereby made a part hereof to enter into a contract in writing for the NOW, THEREFORE, (a) If said Bid shall be rejected, or in alternate, (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the Form of Contract attached hereto (properly completed in accordance with said Bid) and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the owner may accept such Bid; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have cause their corporate seals to be hereunto affixed and these presents to be signed by their proper officers, the day and year first set forth above. (L. S.) Principal Surety SEAL by

DELINQUENT PERSONAL PROPERTY TAX (Must be Executed by the Successful Bidder) A F F I D A VI T STATE OF OHIO ) : SS COUNTY OF ), being first duly sworn, deposes and says that he is of (sole owner, a partner, president, secretary, etc.), the successful bidder on the attached Contract with the City of Bucyrus for, (Describe or identify contract) and for the purpose of complying with Section 5719.042 of the Ohio Revised Code, states that at the time the bid for said contract was submitted, said bidder (was) (was not) charged with delinquent personal property taxes on the General Tax list of personal property of a county in which the City of Bucyrus has territory (Crawford County). The amount of such due and unpaid delinquent taxes, penalties and interest thereon is as follows: Taxes Penalties & Interest County $ $ $ $ $ $ Affiant Sworn to and subscribed before me this day of, 20 Notary Public County My commission expires:, 20

NOTE: In evaluating the bids received, the City of Bucyrus shall follow the criteria and procedures as required of the State Department of Transportation by Ohio Revised Code-Sections 5513.02(B), 125.09, and 125.11(B), in giving preference to United States and Ohio products, per Ohio H.B. 271. THIS AFFIDAVIT MUST BE EXECUTED FOR THE BID TO BE CONSIDERED 1. Do you have facilities within Ohio? Yes No Manufacturing Sales Offices Number of Ohio employees 2. Are products offered in this bid manufactured in Ohio? Yes No If so, state place of manufacture If not, state place of manufacture 3. Are you registered with the Ohio Secretary of State? Yes No Registration Number (UNITED STATES OF AMERICA INFORMATION) 4. Bidder or offeror hereby certifies that each end product, except the end product listed below, is a (U.S.A.) source end product as defined in the ( FEDERAL BUY AMERICA ACT 41 U.S.C. 10 a-d, and 41 C.F.R. SECTION 1-6.101 (D), AS AMENDED AND TO THE REGULATIONS ADOPTED THEREUNDER.) Yes No Exception Company: (Signature) (Title) Sworn to and subscribed before me this day of, 20 (Notary Public), Ohio My commission expires, 20