CITY OF VANDALIA, OHIO INVITATION TO BID FOR Copier Lease. Bid Due Date and Hour: 10:00 AM, April 9, 2018

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1 CITY OF VANDALIA, OHIO INVITATION TO BID FOR 2018 Copier Lease Bid Due Date and Hour: 10:00 AM, April 9, 2018 City Manager s Office City of Vandalia 333 James E. Bohanan Memorial Drive Vandalia, OH 45377

2 Table of Contents Legal Advertisement... 3 Instructions to Bidders... 4 Standard Provisions... 5 Project Summary... 8 Existing Equipment... 9 Removal of Old Equipment... 9 Copier Specifications Service Specifications Cost Structure Lease Renewal Warranty Specifications Monthly Duty Cycle Scope of Work Table Copier Features Project Schedule Required Bid Documents Optional Documents Bid Worksheet A Bid Worksheet B Bid Worksheet C Personal Property Tax Affidavit House Bill Page 2

3 Legal Advertisement The City of Vandalia, Montgomery County, Ohio, will receive sealed proposals for a 60-month, fair market value (FMV) lease for the installation of eleven (11) multifunction copiers/printers at various city buildings and relevant service agreements. The bid shall include the cost for the removal and return shipment of eleven (11) existing copiers to the appropriate leasing agency within 30 days of the installation of the new equipment. Sealed bids must be dropped off at City Manager s Office, 333 James E. Bohanan Memorial Drive, Vandalia, Ohio, by 10:00 a.m. on Monday, April 9, Copies of the scope of work and bid specifications are on file and may be obtained in the City Manager s Office at the above address or online at Inquiries should be directed to Darren Davey, Information Technology Manager (937) Each proposal shall be signed by the full name and address of the company submitting the bid, and envelopes containing the bids shall be sealed and marked on the lower left hand corner "2018 Copier Lease Bid. The proposals shall be made on forms provided in the aforementioned specification packet or on a copy thereof. Proposals that exceed $10,000 shall be accompanied by a certified check or bid bond in the amount of ten percent (10%) of the total lease amount (monthly payment x 60 months x 10%) made payable to the City of Vandalia. The City reserves the right to reject or accept any and all bids, to waive any informality in the bidding, and to enter into a contract with the bidder who, in their consideration, offers the lowest and/or best proposal. The City of Vandalia has a desire to award contracts involving City concerns and funded by City money, to individuals and businesses that are located within the City of Vandalia. Where a preliminary analysis of the bids identifies a bid from a Vandalia individual or business, city council may give a preference to the Vandalia bid and award the contract to the Vandalia bidder when: (i) such bid is within 5% of the lowest bid price (for a low bid of $50,000 or less) or within 2% of the lowest bid price (for a low bid price over $50,000), and (ii) but for the bid price, the Vandalia bid would otherwise be considered the lowest and best bid by the City in its normal evaluation procedures in deciding whether or not to award the contract. Jon Crusey City Manager To Be Advertised: March 25, 2018 Page 3

4 Instructions to Bidders The City of Vandalia, Montgomery County, Ohio, will receive sealed proposals for a 60-month, fair market value (FMV) lease for the installation of eleven (11) multifunction copiers/printers at various city buildings and relevant service agreements. The bid shall include the cost for the removal and return shipment of eleven (11) existing copiers to the appropriate leasing agency within 30 days of the installation of the new equipment. Sealed bids are to be dropped off at City Manager s Office, 333 James E. Bohanan Memorial Drive, Vandalia, Ohio, until 10:00 a.m. on Monday, April 9, Bids received after 10:00 a.m. will not be accepted. A formal public bid opening will be held at 10:00 a.m. on Monday, April 9, 2018, at the following location: Vandalia Municipal Building 333 James E. Bohanan Memorial Drive Vandalia, Ohio Envelopes containing a bidder s proposal shall be signed with the full name and address of the company submitting the bid and envelopes containing the bids shall be sealed and marked on the lower left hand corner "2018 Copier Lease Bid and addressed to: City of Vandalia City Manager s Office 333 James E. Bohanan Memorial Drive Vandalia, Ohio Copies of the scope of work and bid specifications are on file and may be obtained in the City Manager s Office at the above address or online at Any inquiries should be directed to Darren Davey, Information Technology Manager (937) The proposals shall be made on forms provided in this specification packet by the City of Vandalia or on a copy thereof. Proposals that exceed $10,000 shall be accompanied by a certified check or bid bond in the amount of ten percent (10%) of the total lease amount (monthly payment x 60 months x 10%) made payable to the City of Vandalia. The City reserves the right to reject or accept any and all bids, to waive any informality in the bidding, and to enter into a contract with the bidder who, in their consideration, offers the lowest and/or best proposal. The City of Vandalia has a desire to award contracts, involving City concerns and funded by City money, to individuals and businesses that are located within the City of Vandalia. Where a preliminary analysis of the bids identifies a bid from a Vandalia individual or business, city council may give preference to the Vandalia bid and award the contract to the Vandalia bidder when: i. Such bid is within 5% of the lowest bid price (for a low bid of $50,000 or less) or within 2% of the lowest bid price (for a low bid price over $50,000), and ii. But for the bid price, the Vandalia bid would otherwise be considered the lowest and best bid by the City in its normal evaluation procedures in deciding whether or not to award the contract. In case the party to whom the contract is awarded shall fail or neglect to execute the contract and furnish a satisfactory bond within the time specified, the City may determine that the Bidder has abandoned the contract, and thereupon, the proposal and acceptance will be null and void. The bid bond shall be forfeited to be retained by said City as liquidated damages for such failure or neglect and to indemnify the City for any loss which may be sustained by the failure of the Bidder to execute the contract and furnish bond as aforesaid. Page 4

5 Standard Provisions 1. Definitions and Terms In these standard provisions, the following terms shall be interpreted as follows: Bidder : Any person, firm, partnership, limited liability company or corporation submitting a proposal for the project contemplated, acting directly or through a duly authorized representative. Contract : The written agreement between the City of Vandalia, Ohio and the Contractor covering the providing of goods and performance of related services. The terms and conditions of this document shall be deemed incorporated into and considered a part of the Contract. Contractor : The person, firm, partnership, limited liability company or corporation to whom the within Contract is awarded by the Owner, and who is subject to the terms thereof. Department Head : The person identified on the Notice to Bidders or Request for Bids as the contact person for this matter. Owner : The City of Vandalia, Ohio; for purposes of any indemnification, hold harmless, or similar provisions provided to Owner by Contractor, Owner shall include the City of Vandalia s elected and appointed officials, all employees and volunteers, all boards, commissions and/or authorities and board members. Proposal : The offer of the Bidder to provide the goods and/or perform the work. Specifications : The information identified in the Notice to Bidders or Request for Bids. 2. Interpretation of Specifications and Related Documents. If anyone who contemplates submitting a Proposal is in doubt as to the true meaning of any part of the Specifications and related documents, such person may submit to the Department Head a written request for an interpretation thereto. No interpretation of the specifications and related documents will be made except through a Memorandum duly issued by the Department Head, and a copy of such Memorandum will be mailed or delivered to each known person securing the specifications provided that a sufficient period of time is available for the issuance of such Memorandum prior to the receipt of bids, and such Memorandum shall be attached to and become part of these Specifications. 3. Personal Examination. Submitting a Bid is an affirmative statement that the Bidder has fully examined the Specifications and is satisfied as to the character, quality, quantities, and the conditions contained therein. No pleas of ignorance as the result of failure to make such examination will be accepted as an excuse for any failure or omission on the part of the Contractor to fulfill in every respect all the requirements of the Contract, nor will the same be accepted as a basis for any claim whatsoever for extra compensation or for extension of time. 4. Proposal. Any Bidder may withdraw a Proposal, providing a written request is received by the Owner prior to the specified time of the opening of bid, a Bidder may change or modify a Proposal in the same manner in which it was originally submitted, but no Bidder may withdraw a Proposal after the specified time of the opening of bids. Proposals received after the specified time of the bid opening will be returned to the Bidder unopened. Telegraphic, faxed and bids will not be considered. Proposals with all required supporting documents shall be sealed in an envelope and shall have the following information inscribed in the upper left-hand corner: The name of the Bidder, bid for (give title as advertised), bid opening date. 5. Preparation and Submission of Bids. All bids shall be signed in ink by an authorized representative of the Bidder. Erasures or changes in a bid must be explained or noted over the signature of the Bidder. Bids containing any conditions, omissions, unexplained erasures, alteration of forms, or irregularities of any kind may be rejected by the Owner; however, the Owner reserves the right to accept or to reject any or all bids and to waive defects, informalities or technicalities as it may deem best for it interest. The sum of the individual bid items shall control, if there is any discrepancy between itemizations and the total in a Proposal. Whenever in any Specifications an article, material, or equipment is defined by describing a proprietary product or by using the name of a manufacturer or vendor, it is done for the express purpose of establishing a basis for the type of function, quality, durability and efficiency and not for the purpose of limiting competition. Page 5

6 6. Final Award. The Contract shall be considered to have been awarded and binding upon the contracting parties on or after the date of a notice of award from the Owner. 7. Laws, Ordinances, and Regulations. The Contractor shall keep itself fully informed of and shall carefully observe and comply with all federal, state, county, city, and local laws, ordinances, rules, permits, licenses, relative to performance under the Contract. 8. Patents. The Contractor will be required to indemnify, keep and save harmless the Owner from any and all liabilities, judgments, costs, damages or claims for damages which may arise from the infringement of patented design, device, material, process, of any trademark or copyright, of any letter patented, patent rights, or royalty due on the same by reason of the use of any patented or copyright materials, machinery, devices, and equipment furnished or used in the performance of this Contract, or by reason of the use of patented or copyrighted designs furnished and incorporated into the work by the Contractor and accepted by the Owner, excepting equipment furnished by the Owner. In the event that any claim, suit or action at law or equity of any kind whatsoever is made or brought against the owner involving any such patents, then the Owner shall have the right to retain from the money due and/or to become due the Contractor, a sufficient amount of money as shall be considered necessary by the Legal Advisor of the Owner, to protect him against loss until such claim, suit, or action shall have been settled and evidence to the effect shall have been furnished to the satisfaction of the said Legal Advisor. 9. Taxes. Unless otherwise specified, the Contractor will be required to pay, without additional expense to the Owner, all federal, state, & local sales and any other taxes which may be applicable under this Contract. 10. Assignments. The Contractor may not assign the whole or any part of the Contract or any moneys due and/or to become due hereunder without written consent of the Owner. 11. Legal Requirements. The intent of the Contract is to include each and every provision of law and clause required by law to be inserted herein, and it shall be read and enforced as though they were included herein. If any legal provision is required by applicable law to be contained in the Contract and through mistake or otherwise was omitted or not correctly stated, then the Contract shall forthwith be amended to include such legal provision. 12. Tax Affidavit. After the award of the Contract, Contractor shall submit to the City a statement affirmed under oath that the Contractor was not charged at the time the bid was submitted with any delinquent personal property taxes on the general tax list of personal property of any county in which the City has territory or that the Contractor was charged with delinquent personal property taxes on any such tax list, in which case the statement shall also set forth the amount of such due and unpaid delinquent taxes and any due and unpaid penalties and interest thereon. If the statement indicates that the taxpayer was charged with any such taxes, a copy of the statement shall be transmitted by the fiscal officer to the county treasurer within thirty days of the date it is submitted. 13. Audit Examinations. Contractor shall be required to have available to the Owner, the state auditor, or any of their duly authorized representatives, access to any books, documents, papers and records of the contractor as may be required of Contractor under law for purpose of making audit, examinations, excerpts, and transcriptions. 14. H.B. 694 Certification. House Bill 694, which became effective on April 4, 2007, provides that a City may not award a contract to purchase goods or services of more than $500 to a provider if that provider made certain political contributions to a City Council member in the two calendar years prior to the year in which the contract is awarded. Further, prior to entering into a contract in excess of $500 a City must obtain a certification that the provider of goods or services under that contract is in compliance with House Bill 694. The Contractor shall certify that all of the following persons, (as applicable), are in compliance with division (I)(1) of House Bill 694: (a) The individual if the contract is with an individual; (b) Each partner or owner if the contract is with a partnership or other unincorporated business; (c) Each shareholder if the contract is with an association; (d) Each administrator if the contract is with an estate; (e) Each executor if the contract is with an estate; (f) Each trustee if the contract is with a trust; (g) Each spouse of any person identified in section a-f above; (h) Each child seven years of age to seventeen years of age of any person identified in section a-f above (i) Any combination of persons identified in sections a-h above; (j) Each owner of more than 20% of the corporation or business trust if the contract is with a corporation or business trust; (k) Each spouse of any person identified Page 6

7 in section j; (l) Each child seven years of age to seventeen years of age of any person identified in section j above; (m) Any combination of persons identified in sections j-l above. 15. Vandalia First. Where a preliminary analysis of the bids identifies a bid from a Vandalia individual or business, city council may give a preference to the Vandalia bid and award the contract to the Vandalia bidder when: (i) such bid is within 5% of the lowest bid price (for a low bid of $50,000 or less) or within 2% of the lowest bid price (for a low bid price over $50,000), and (ii) but for the bid price, the Vandalia bid would otherwise be considered the lowest and best bid by the City in its normal evaluation procedures in deciding whether or not to award the contract. PSE Page 7

8 Project Summary The City of Vandalia utilizes multifunction copiers/printers throughout the city. These devices are normally leased on a 60-month, fair market value lease. After the lease matures, we replace the old equipment with new. The city currently has nine (9) copiers that are leased from ProSource, which will be maturing in May Two other copiers are being billed month to month. The city will be replacing the eleven (11) copiers with new equipment and placing them all on the same lease. The new equipment is to have the same or better functionality than what is currently in place. The majority of the copiers are Konica Minolta BizHub devices. These devices have been very reliable and the interface on the copiers has been easy for users to use and understand. As the city looks to replace these devices, the same level of reliability and usability need to be evident in the proposed equipment. The bid specifications in this bid packet outline the copier speed and functions that are required for each location. After receiving bids from the vendors, we will look at several of the lowest bid equipment to see how they function and perform. While a low bid price is important, other factors will be taken into account as well, including the copier reliability and user reviews, service and support, customer references, the availability of technicians, and the overall usability of the devices. Page 8

9 Existing Equipment Eleven (11) copiers will be replaced by the new lease. Nine (9) of the copiers are on a lease with ProSource, with a maturity date of May, An additional copier was leased from ProSource, but the lease has matured and the copier is being billed month-to-month. The last copier was leased through Business Equipment Corporation (BEC), but has matured and is being billed month-to-month. Prosource Lease, Expiring May 2018 City Manager s Office Bizhub C454 Staple Finisher, FAX, Folding Unit Trifold 3 Pages Development and Engineering Bizhub C454 Staple Finisher, FAX Services Public Works Bizhub C224 Staple Finisher, FAX Parks and Recreation Bizhub C554 Staple Finisher, FAX, Folding Unit Trifold 3 pages, Saddle Stitch and Fold Police Admin Bizhub C454 Staple Finisher Police Records Bizhub C454 Staple Finisher, FAX Tax Bizhub C554 Staple Finisher, FAX Finance Bizhub C554 Staple Finisher, FAX Fire Station 1 Bizhub C224 Staple Finisher, FAX ProSource Lease, expired, month-to-month Golf Clubhouse Bizhub 223 FAX Business Equipment Lease, expired, month-to-month Building Maintenance Copystar CS-255. FAX Removal of Old Equipment Within thirty (30) days of the installation date, the copiers must be removed and shipped back to the leasing agent. The cost of packaging and shipping the equipment is the responsibility of the CONTRACTOR. Any damages that may occur during the shipment of the equipment is the responsibility of the CONTRACTOR. Addresses for each location are listed in Table 1. Page 9

10 Copier Specifications A. The CONTRACTOR shall provide all supervision, equipment, and labor to supply, deliver and install eleven (11) multifunction copiers with varying speeds and options as listed in Table 1. B. All copiers shall be of the same brand/manufacturer, and all parts and accessories shall be made by the copier s original equipment manufacturer (OEM). C. All copiers shall be new equipment, model year 2017 or newer. D. All copiers shall use the same common user interface at the copier console. E. All copiers shall be able to print black and color. F. All copiers shall include the following options and features a. Scan to file and as PDF, TIFF, and JPG b. Duplex printing c. Postscript standard d. Black/Color, Single Pass Double Sided Scanning e. Speed dial / quick access buttons G. All copiers shall have network print capabilities from Windows workstations. H. All copiers, except the Police Admin copier, shall have fax capabilities. This includes the ability to forward faxes to addresses or to print. I. All copiers must meet the minimum speed listed in Table 1 for each location for black copies. Service Specifications A. Meter reads should be collected remotely with automated software. B. Monthly volume shall be based on a combined volume 60,0000 black pages per month and 16,000 color pages per month. Quarterly billing and equalization is preferred. C. Monthly/quarterly service and maintenance rates must remain fixed for the term of the lease. Page 10

11 Cost Structure A. The bid amount listed by the bidder to City of Vandalia is to be an all-inclusive, monthly payment to include all hardware, software service, maintenance, end user training, parts and all supplies (excluding paper and staples) for the monthly volume listed under Service Specifications. B. Proposals must include leasing options and maintenance agreement proposals for a 60- month, fair market value lease. The lease date shall begin 5/22/2018. C. Proposals and subsequent monthly invoices shall not include any additional charges outside of the standard lease. There will be NO allowable charges for scans. The City will not be responsible for any additional freight cost of shipping toner from the provider. D. Monthly/quarterly service and maintenance rates must remain fixed for the term of the lease. E. The City will not be responsible for Lease Origination Fee or UCC Filing Fee. Lease Renewal At the end of the 60-month lease, the lease shall automatically renew on month-to-month terms unless the equipment is purchased or returned. A 30-day notice from the City shall be given to the leasing agency prior to maturity if the lease is not to be renewed on month-to-month terms. Warranty Specifications Equipment repairs shall be covered for the term of the contract, including parts and labor. Monthly Duty Cycle The copiers specified in Table 1 should have a recommended monthly duty cycle listed below, based on the speed of the copier: 25 ppm 5,000 pages/month or higher 42 ppm 10,000 pages/month or higher 52 ppm 20,000 pages/month or higher Page 11

12 Scope of Work A. CONTRACTOR shall furnish and install all equipment proposed by the date indicated in the Project Timeline. B. CONTRACTOR is responsible for the removal and return of existing machines to current lease company within thirty (30) days of installing the new equipment. C. CONTRACTOR shall fully configure the network and fax settings at each location. D. CONTRACTOR shall perform training sessions at each site for up to five (5) users per copier. E. CONTRACTOR shall agree to subsequent annual "refresher" training at each site, at no additional cost. F. CONTRACTOR shall program up to twenty (20) prior contacts into each new copier. G. CONTRACTOR shall configure paper trays as determined by the department contact upon installation. H. CONTRACTOR shall install the necessary drivers on at least two (2) workstations to allow printing from Windows. Page 12

13 Table 1 Building Maintenance 25-A Color x14 2 X X X X X 1151 Stonequarry Road, Vandalia Clubhouse 25-B Color x14 2 X X X X X 201 Clubhouse Way, Vandalia Station 1 25-C Color 22 11x17 2 X X X X X X X X 8705 Peters Pike, Vandalia Service Garage 25-D Color 22 11x17 2 X X X X X 97 Clubhouse Way, Vandalia Police Admin 42-E Color 42 11x17 4 X X X X X X 245 James Bohanan Drive, Vandalia Police Records 42-F Color 42 11x17 4 X X X X X X X 245 James Bohanan Drive, Vandalia DES 42-G Color 42 11x17 4 X X X X X X X 333 James Bohanan Drive, Vandalia Finance 42-H Color 42 11x17 2 X X X X X X X X X 333 James Bohanan Drive, Vandalia Rec Center 52-I Color 52 11x17 2 X X X X X X X X X X 1111 Stonequarry Road, Vandalia City Manager 52-J Color 52 11x17 4 X X X X X X X 333 James Bohanan Drive, Vandalia Tax 52-K Color 52 11x17 2 X X X X X X X X X 333 James Bohanan Drive, Vandalia Note: "X" indicates required item/feature Department Name Copier # Type Copier Minimum Speed Paper Size Min Drawers Sheet Large Capacity Drawer FAX Inner Finisher (500) Finisher (200/2000) Stapler (50) Job Separator (fax, print, copy) Fold / Tri-Fold Hole Punch Account Codes Duplex Print Single Pass Scanning Scan to Floor Stand Address Page 13

14 Copier Features Type All copiers shall be able to print black/mono and color. Copier Minimum Speed All copiers must be able to print black/mono copies at the speed indicated in the table. Copiers may print faster. Paper Size Min The copier must be able to print the size listed, but may print larger sizes as well. Drawers 500 Sheet The copier must include the number of drawers listed with the ability to hold 500 sheets of paper per drawer. Copiers with only two (2) drawers may require additional space holders in order to allow the device to include a floor stand. Large Capacity Drawer The copiers must include the number of drawers listed with the ability to hold at least 2000 sheets of paper. This count is separate from the Drawers 500 Sheet, listed above. For example, the Finance Copier, 42-H, must include two (2) 500 page drawers and one (1) large capacity drawer. FAX Copiers with this designation must include the ability to FAX documents. Inner Finisher An inner finisher should include the ability to staple up to 50 sheets of plain paper, as well as stack 500 sheets of plain paper. Finisher (200/2000) The external finisher should include the ability to staple up to 100 sheets of plain paper, as well as stack 200 sheets of plain paper in the first output tray and up to 2000 sheets in the secondary output tray. The finisher should have the ability to stagger jobs in the output tray. Stapler (50) This is listed separately for clarification, but each copier with a finisher should include the ability to staple up to at least 50 sheets of plain paper. Copiers with larger finishers may require a larger staple ability. Job Separator The job separator that is currently used on the Konica Minolta Bizhub C554 is a JS-602 Job Separator, which allows the fax/print/copy output to go to separate trays. The copier for this location should include a job separator with similar features. Fold / Trifold Copiers with this feature should be able to half-fold and tri-fold paper. Page 14

15 Hole Punch Copiers with this feature should be able to three hole punch paper. Account Codes Copiers at these locations should be able to restrict printing by account codes. This includes local copying, or remote printing from PCs. Duplex Print All copiers should include duplex printing. Single Pass Scanning All copiers should include single pass, duplex scanning. Scan to All copiers should be able to scan to an address as well as SMB share. Floor Stand All copiers should be free standing, floor models. Address This is the address of each copier location. Page 15

16 Project Schedule 3/25/2018 Bid Published 4/9/2018 Bids Due by 10:00 AM Bid Opening at 10:00 AM 4/10/2018 City to begin evaluating bids and visit best bidders to evaluate equipment 5/7/2018 Recommendation presented to city council 5/21/2018 Council to approve lease agreement 5/22/2018 Signing of all necessary lease paperwork 6/4/2018 Installation window open 6/29/2018 Installation and training to be completed 7/29/2018 Old copiers to be shipped back to leasing agents Page 16

17 Required Bid Documents 1. Bid Bond or Certified Check for 10% of total lease amount (total monthly payment x 60 months x 10%) 2. Bid Worksheet A Signed 3. Bid Worksheets B & C 4. Draft Lease Documents 5. Draft Service Agreement Documents 6. Personal Property Tax Affidavit Signed and Notarized 7. House Bill 694 Signed Optional Documents 1. Product Literature 2. Customer References 3. Company Literature 4. Related Documents Page 17

18 Bid Worksheet A Company Name: Street Address: City, State, Zip: Total Equipment Cost Lease Breakdown Leasing Agency Name: A. Monthly Equipment Cost: B. Monthly Service Cost: Total Monthly Cost: (A+B) Total Cost Over Term: (A+B) * 60 Months Black Base Monthly Vol (60,000 min) Color Base Monthly Vol (16,000 min) Black Overage Rate Color Overage Rate Signature Date Printed Name Page 18

19 Bid Worksheet B Bid Specifications Copier # Speed B/C Model Quoted Options Quoted (include Part #s) 25-A 25-B 25-C 25-D 42-E 42-F 42-G 42-H 52-I 52-J 52-K List Bid Exceptions: Page 19

20 Bid Worksheet C A. Describe service call hours, staffing and after hour capabilities. B. Describe guaranteed response time for a technician to be on site. C. What is the average tenure of your technicians that will be working on the proposed equipment? D. How many technicians are available to service the City that are certified specifically for the brand of the equipment you are proposing? E. Describe the preventive maintenance schedule. F. What supply items are included in the cost(s) of the proposal? G. Describe how each building will receive their supplies and place service calls through your current processes within your organization. H. Briefly describe the quality assurance guarantees you offer. I. Describe your Help Desk support. J. Regarding the reseller/service company (not manufacturer) a. What is your local office address? b. Where is your company headquartered? c. How many years have you been in business? Page 20

21 Personal Property Tax Affidavit State of County of The undersigned, being first duly sworn, deposes and says that I am (sole owner, partner, president, secretary, etc.) of the party making the foregoing Bid and the party awarded the Contract by the Owner. Furthermore, I hereby affirm under oath, pursuant to Section of the Ohio Revised Code, that at the time the Bid was submitted, the above party (was) (was not) charged with delinquent personal property taxes on the General Tax List of Personal Property for Montgomery County, Ohio. If such charge for delinquent personal property tax exists on the General Tax List of Personal Property for Montgomery County, Ohio, the amount of such due and unpaid delinquent taxes, including due and unpaid penalties and interest shall be set forth below. In such case, a copy of this statement shall be transmitted by the Director of Finance to the County Treasurer within 30 days of the date it is submitted. Delinquent Personal Property Tax $ Penalties $ Interest $ Signed: Title Subscribed and sworn to before me on this day of, 20. Page 21 Notary Public

22 House Bill 694 "Under House Bill 694, effective April 4, 2007, no political subdivision may enter into a contract in excess of $10,000 unless the contract includes a certification that the provider of goods or services under that contract is in compliance with House Bill 694. (Insert Name of Bidder) hereby certifies that all of the following persons, if applicable, are in compliance with division (I)(1) of House Bill 694: (a) The individual if the contract is with an individual; (b) Each partner or owner if the contract is with a partnership or other unincorporated business; (c) Each shareholder if the contract is with an association; (d) Each administrator if the contract is with an estate; (e) Each executor if the contract is with an estate; (f) Each trustee if the contract is with a trust; (g) Each spouse of any person identified in section a-f above; (h) Each child seven years of age to seventeen years of age of any person identified in section a-f above; (i) Any combination of persons identified in sections a-h above; (j) Each owner of more than 20% of the corporation or business trust if the contract is with a corporation or business trust; (k) Each spouse of any person identified in section j; (l) Each child seven years of age to seventeen years of age of any person identified in section j above; (m) Any combination of persons identified in sections j-l above." (House Bill 694, which became effective on April 4, 2007, provides that a City may not award a contract to purchase goods or services of more than $10,000 to a provider if that provider made certain political contributions to a City Council member in the two calendar years prior to the year in which the contract is awarded. Further, prior to entering into a contract in excess of $10,000 a City must obtain a certification that the provider of goods or services under that contract is in compliance with House Bill 694). Signature Date Page 22