MIAMI VALLEY COMMUNICATIONS COUNCIL 1195 EAST-ALEX BELL ROAD, CENTERVILLE, OHIO PHONE: / FAX: / INTERNET:

Similar documents
STATEMENT OF BIDDER'S QUALIFICATIONS

PLEASANTVILLE HOUSING AUTHORITY

G E O R G I A P O R T S A U T H O R I T Y I N S U R A N C E R E Q U I R E M E N T S

BOROUGH OF TOTOWA NOTICE AND SOLICITATION OF PROPOSALS FOR THE POSITION OF TAX APPEAL CONSULTANT FOR THE BOROUGH OF TOTOWA

TOWNSHIP OF WOOLWICH 120 VILLAGE GREEN DRIVE WOOLWICH TOWNSHIP, NJ SPECIFICATIONS AND RFP FORMS FOR PROFESSIONAL SERVICES CONTRACTS YEAR 2019

BOROUGH OF TOTOWA NOTICE AND SOLICITATION OF PROPOSALS FOR RISK MANAGEMENT CONSULTANT SERVICES FOR THE BOROUGH OF TOTOWA

ADDENDUM TO INVITATION FOR BIDS Fortuna Union High School District Proposition 39 LED Lighting Retrofit Bid No Addendum #2 February 23, 2017

MONROE TOWNSHIP SCHOOL DISTRICT REQUEST FOR PROPOSAL FOR: Insurance Brokerage Services Property & Casualty and Workers Compensation

WINDOW WASHING

BOROUGH OF TOTOWA NOTICE AND SOLICITATION OF PROPOSALS FOR PROFESSIONAL ENGINEERING SERVICES FOR THE BOROUGH OF TOTOWA

FULTON COUNTY, OHIO 703 Aggregate THURSDAY DECEMBER 4, :00 A.M.

HOUSING AUTHORITY OF THE TOWN OF MORRISTOWN REQUEST FOR PROPOSALS FEE ACCOUNTING SERVICES

SOMERSET COUNTY INSURANCE COMMISSION

BID DOCUMENTS FOR ACCU-TAB SL CAL HYPO TABLETS FOR USE IN WATER TREATMENT

REQUIRED BID FORMS SECTION

GUTTENBERG HOUSING AUTHORITY

BID DOCUMENTS FOR SAND, GRAVEL & LIMESTONE BID

Housing Authority of the Borough of Keansburg

MANTUA TOWNSHIP MUA FEE ACCOUNTING SERVICES

CAMDEN COUNTY EDUCATIONAL SERVICES COMMISSION 225 White Horse Avenue Clementon, New Jersey 08021

VIRGIN ISLANDS PORT AUTHORITY ENGINEERING DIVISION

TOWNSHIP OF HAZLET REQUEST FOR QUALIFICATIONS FOR HEALTH INSURANCE CONSULTANT TOWNSHIP OF HAZLET COUNTY OF MONMOUTH STATE OF NEW JERSEY

LINCOLN PARK BOARD OF EDUCATION REQUEST FOR PROPOSALS FOR ARCHITECTURAL SERVICES

City of Laguna Niguel Solicitation of Informal Sealed Bids for the Replacement of Diving Platform Hand Rail and Spiral Stairs Cash Contract 18-06

CITY OF GALESBURG. PURCHASING 55 W Tompkins St Galesburg, IL Phone: (309)

BID RECEIVING OFFICE: Forsyth County Public Library, Administrative Offices, 585 Dahlonega Street, Cumming, GA 30040

TOWNSHIP OF BLOOMFIELD STANDARDIZED SUBMISSION REQUIREMENTS FOR PROFESSIONAL SERVICES INFORMATION FOR PROFESSIONAL SERVICES ENTITIES

BID DOCUMENTS FOR STRYKER POWER-PRO XT COT

REQUEST FOR SEALED PROPOSALS

BID DOCUMENTS FOR. WTP VFD Replacement Bid

LEAF VACUUM CURBSIDE COLLECTION INCLUDING EQUIPMENT AND OPERATOR

GALESBURG PUBLIC LIBRARY 40 E. SIMMONS STREET GALESBURG, ILLINOIS f

Contract Documents. And. Specifications. For. Engler Park Dressing Room Building

PUBLIC NOTICE BRICK TOWNSHIP MUNICIPAL UTILITIES AUTHORITY 1551 HIGHWAY 88 WEST, BRICK, NJ NOTICE OF SOLICITATION FOR RFQs

REQUEST FOR PROPOSALS FOR SERVICES OF FUND ATTORNEY /REGULATORY COMPLIANCE & LEGISLATIVE SERVICES

BOROUGH OF ELMWOOD PARK REQUEST FOR QUALIFICATIONS AND PROPOSAL FOR MUNICIPAL BOND COUNSEL

CITY OF TITUSVILLE, FLORIDA

BOROUGH OF TOTOWA NOTICE AND SOLICITATION OF PROPOSALS FOR ANIMAL CONTROL OFFICER FOR THE BOROUGH OF TOTOWA

TOWNSHIP OF RARITAN REQUEST FOR QUALIFICATIONS RISK MANAGEMENT CONSULTANT SUBMISSION DEADLINE AT WHICH TIME PROPOSALS WILL BE OPENED IS

NOTICE TO BIDDERS CUSTODIAL SUPPLIES

BID PACKAGE for the SCALES REPLACEMENT

CITY OF GALESBURG. PURCHASING 55 West Tompkins Street Galesburg, IL Phone: 309/ INVITATION FOR BIDS

REQUEST FOR PROPOSAL & QUALIFICATIONS (RFP) FOR THIRD-PARTY AGENCIES

CITY OF GALESBURG. PURCHASING 55 West Tompkins Street Galesburg, IL Phone: 309/ INVITATION FOR BIDS

LOUISIANA UNIFORM PUBLIC WORK BID FORM

TOWN OF HARRISON PLANNING BOARD PUBLIC NOTICE FOR SOLICITATION PROFESSIONAL SERVICE CONTRACT JANUARY 1, 2019 THROUGH DECEMBER 31, 2019

REQUEST FOR PROPOSAL FOR RISK MANAGEMENT CONSULTANT

City of Portsmouth Portsmouth, New Hampshire Department of Public Works. Plumbing and Heating Repair Services

December 12, To Whom It May Concern: Enclosed please find our Request for Professional Services.

THE UNIVERSITY OF THE WEST INDIES, MONA CAMPUS Procurement Policies and Procedures Manual. Appendices APPENDICES

Request for Proposal for Professional Services

HOUSING AUTHORITY OF THE TOWN OF MORRISTOWN REQUEST FOR PROPOSALS ORDINARY LEGAL SERVICES

Proposal No:

JEFFERSON PARISH SHERIFF S OFFICE INSTRUCTIONS TO BIDDERS AND GENERAL CONDITIONS PUBLIC WORKS/CONSTRUCTION PROJECTS

Union Township, Clermont County PARK & RIDE IMPROVEMENTS

INFORMATION FOR BID. Tee Shirts (School Nutrition)

CITY OF GALESBURG. PURCHASING 55 West Tompkins Street Galesburg, IL Phone: 309/ INVITATION FOR BIDS

Bid Document Submission Checklist Township of Long Beach Air Conditioning, Heating & Refrigeration Service, Maintenance & Repair

All responses to quotations must be received by Procurement Services no later than 3:00 p.m. on Thursday, February 3, 2005.

REQUIRED BID FORMS SECTION

CITY OF GALESBURG. PURCHASING 55 West Tompkins Street Galesburg, IL Phone: 309/

TOWNSHIP OF HAZLET COUNTY OF MONMOUTH STATE OF NEW JERSEY PROFESSIONAL SERVICES SOLICITATION FAIR & OPEN PUBLIC SOLICITATION PROCESS

BID DOCUMENTS FOR THERMAL IMAGING CAMERA

CITY OF GALESBURG. PURCHASING 55 W Tompkins St Galesburg, IL Phone: (309)

HVAC SYSTEM IMPROVEMENT for COUNTY ENGINEER OFFICE in SANDUSKY COUNT, OHIO BIDS RECEIVED APRIL 13, 2010 AT 10:30 AM ENGINEER S ESTIMATE: $128,000.

The Housing Authority of the Township of Middletown

HABERSHAM COUNTY Office of County Commissioners 555 Monroe Street, Unit 20, Clarkesville, GA Fax:

Request for Proposals For: HQS Inspection Services From June 1, 2017 May 31, April 2017

5. BID FORMS TABLE OF CONTENTS

BOROUGH OF HIGHTSTOWN REQUEST FOR PROPOSAL GRANT WRITING & CONSULTING SERVICES

TOWN OF GUTTENBERG COUNTY OF HUDSON, STATE OF NEW JERSEY

TOWNSHIP OF PEQUANNOCK. REQUEST FOR PROPOSALS for PROFESSIONAL SERVICES 2018 FEMA FMA HOME ELEVATION GRANT APPLICATION

COUNTY OF COLE JEFFERSON CITY, MISSOURI

Insurance Requirements for Contractors

REQUEST FOR QUALIFICATIONS TOWNSHIP AUDITOR

CITY OF TUMWATER SERVICE PROVIDER AGREEMENT (TOWING CONTRACT) THIS AGREEMENT is made and entered into in duplicate this 1 st day of

BOROUGH OF HIGHLANDS COUNTY OF MONMOUTH STATE OF NEW JERSEY REQUESTS FOR PROPOSAL & QUALIFICATIONS BOROUGH PLANNER

[MASTER ESCROW AGREEMENT - AUTHORITY FORM] ESCROW AGREEMENT. by and among NEW JERSEY ENVIRONMENTAL INFRASTRUCTURE TRUST,

Request for Qualifications

NOTICE TO BIDDERS. Four (4) 2018 Harley Davidson Road King Police Model Motorcycles (FLHP) in solid luxury blue or equal

GUILFORD COUNTY SCHOOLS Invitation for Bids

Request for Proposals 2018 Erosion Control Project. Madison, Wisconsin

REQUEST FOR SEALED PROPOSALS

LITCHFIELD MUNICIPAL AIRPORT LITCHFIELD, ILLINOIS. Request for Bids and Specifications Sealcoating and Painting Runway 18/36 and Associated Taxiways

LA COSTA PRESSURE REDUCING STATION REPLACEMENT PROJECT

Contract Documents. and. Specifications. for. Engler Park Tennis Court Construction

RFP-FD Replacement Mid-Mount Tower Ladder. Required Submittals

Request for Proposals For: Legal Services. From April 1, March 31, 2021 for the HIGHLAND PARK HOUSING AUTHORITY.

BIDDER S QUALIFICATION AND EXPERIENCE STATEMENT

INSTRUCTIONS TO BIDDERS

performed 9. For provider complaints: MC-7

Gloucester City Public Schools 520 Cumberland Street Gloucester City, New Jersey 08030

BULLOCH COUNTY BOARD OF COMMISSIONERS 115 NORTH MAIN STREET STATESBORO, GEORGIA (912)

ADVERTISEMENT FOR BIDS GRATIOT COMMUNITY AIRPORT MOWING SERVICES BID B. Mowing services for the Gratiot Community Airport

CONTRACT DOCUMENTS AND SPECIFICATIONS

SOUTHERN REGIONAL WASTEWATER TREATMENT PLANT CRYOGENIC PLANT TURNAROUND MAINTENANCE Year 2016

HABERSHAM COUNTY Office of County Commissioners 555 Monroe Street, Unit 20, Clarkesville, GA

LEGAL NOTICE VILLAGE OF ORLAND PARK, ILLINOIS ADVERTISEMENT FOR BIDS SHADE STRUCTURES FOR DUGOUTS

LINCOLN UNIFIED SCHOOL DISTRICT CHROMEBOOK BID

Boulder Creek Fire Protection District. Request For Proposal. Voluntary Seismic and ADA Station Upgrades. July 14, 2015

Transcription:

MIAMI VALLEY COMMUNICATIONS COUNCIL 1195 EAST-ALEX BELL ROAD, CENTERVILLE, OHIO 45459 PHONE: 937-428-8887 / FAX: 937-438-8569 / INTERNET: www.mvcc.net STANDARD CONDITIONS FOR COMPETITIVE BIDDING 1. All bids must be in the possession of the Miami Valley Communications Council (MVCC) on or before the time set for opening. Bids received after that time, whether from the bidder or through some third party (e.g., FedEx, U.S. Postal Service) will be returned unopened. 2. The outside envelope containing the bid must be clearly marked on its exterior: SEALED BID INDIGENT BURIAL SERVICES. 3. MVCC reserves the right to hold all bids for review for 60 days, unless some different requirement or standard is stipulated in the specification for the particular item/service/contract. 4. It is MVCC s policy, whenever possible, to use open, non-exclusionary specifications, to promote competition, and to make the process as accessible to bidders as possible, consistent with protecting its own interests. We may often cite a particular brand or model or practice as the standard. Bidders are welcome to propose alternates or substitutes which will either provide the same performance at lower cost, or better performance at the same cost. Bidders wishing to propose alternates should bid on the item as specified, and offer the alternate or substitute separately, as a footnote. Acceptance of alternates or substitutes shall be at the sole discretion and judgment of MVCC and its member cities. 5. MVCC intends to award bids on a best bid basis. That means we will consider, in addition to price, such factors as: a. Ability to perform the service and work within the specified time b. Reputation, judgment and experience c. The quality of performance in previous contracts d. Financial ability to perform the contract e. Ability to provide maintenance and service f. Demonstrated past performance in similar situations g. Life cycle costs of the items. 6. All bidders are required to be, at the time of their bid and during the term of any contractual relationship with MVCC, in compliance with all applicable local, state, and federal laws. Page 2

7. MVCC is a political subdivision of the State of Ohio and therefore exempt from most state and federal taxes. 8. All prices must include delivery to such locations identified in the specifications. 9. MVCC will not accept liability for any acts of the contractor attendant to performance of any contract. By bidding, any contractor agrees to hold MVCC harmless in regard to any claims arising from contractor s acts. 10. Contractors perming work for MVCC under contract are required to maintain worker compensation insurance as required by Ohio law, and comprehensive liability insurance in the amount of $1,000,000.00. 11. MVCC reserves the right to accept or reject any or all bids and to waive any formalities in the bidding process whenever it is in the interest of its member cities, and to enter into a contract with the bidder who, in MVCC s opinion, offered the lowest and best bid. Page 3

REQUEST FOR BIDS AND SPECIFICATIONS INDIGENT FUNERAL SERVICES MIAMI VALLEY COMMUNICATIONS COUNCIL ITEMS REQUESTED The Miami Valley Communications Council (MVCC) is seeking bids from qualified contractors to provide indigent funeral services for its member cities. The specifications and scope of services that follow are intended to describe the work required and the minimum standards for materials and application. The contractor is to supply all materials, equipment, and labor necessary to complete the specified work. THE CONTEXT MVCC is a council of governments with eight member cities. In this instance we are acting to assist those members in a cooperative bid for indigent funeral services. MVCC is coordinating and overseeing the process on behalf of its members, each of whom will review the bid results and decide individually whether or not to make an award. Each individual city will review the work of the contractor and pay the contractor directly. Those cities participating in this bid solicitation include: Centerville Germantown Kettering Miamisburg Moraine Oakwood Springboro West Carrollton. ATTACHMENTS/INCLUSIONS BY REFERENCE There are several items which are hereby included in this specification, either attached or by reference. Those listed as forms for all bidders must be completely and properly executed and included with the bid. - A document titled: STARDARD CONDITIONS FOR COMPETITIVE BIDDING (attached) - Forms for all bidders: - proposal and bid form (attached) - certificate of non-collusion (attached) - affidavit that all personal property taxes are current (attached) - certificate of non-discrimination (attached) - bid bond (attached) - statement of experience, list of references (attached) - Successful bidder: - performance bond (provided by bidder) - maintenance bond (provided by bidder) - certificates of insurance (provided by bidder) - contract (provided by participating municipality) BID DUE DATE/TIMEFRAME The first advertisement soliciting bids for these services should appear on July 29, 2015. Bids will be received until 11:00 AM, Thursday, August 13, 2015 at the offices of the Miami Valley Communication Council at 1195 East Alex-Bell Road, Centerville, Ohio 45459; phone 937-438-8887; fax 937-438-8569; URL www.mvcc.net. At Page 4

that time all bids will be opened in the small conference room on the second floor, read aloud, and tabulated. Bidders and other are invited to attend this public proceeding. SCOPE OF SERVICES 1. It is anticipated that 20 to 25 indigent funerals will occur each year amongst the member cities. 2. Any individual who has a deceased family member, or any individual responsible for the body of a deceased person, who believes that person is eligible for funeral assistance due to indigence, will be referred to the successful bidder. 3. The successful bidder shall verify the legal residence of the deceased person. 4. The successful bidder shall be responsible to verify indigence. Indigence is defined per Ohio Revised Code Section 9.15, as having an income that does not exceed one hundred fifty per cent of the federal poverty line, as revised annually by the United States Department of Health and Human Services. A copy of the latest established levels is attached to this Request for Proposals. MVCC shall provide updated income limits information when such has been promulgated. 5. The successful bidder shall use the form provided by MVCC to document indigence (a copy of the current form is attached to this Request for Proposals). In performing such documentation, the successful bidder shall first verify that the individual is not eligible for burial assistance from any other sources (i.e. welfare/state assistance, veteran s assistance, social security, etc.) and that the person and/or family claiming the body (if any) are determined to be indigent. If the individual and the person/family claiming the body are indigent, but eligible for assistance from other sources, the successful bidder shall be responsible for processing the claims for assistance and applying said to the charges for this funeral. 6. Upon verification of indigence, the successful bidder shall be responsible for accepting and transporting the body from the Coroner s office or wherever the body is located at that time to their facilities. 7. All bodies to be handled under this program are to be cremated. Bodies are to be cremated in accordance with State law and accepted industry practices. All cremains are to be placed in a basic urn (description/photo of which shall be submitted with bid proposal, and must be approved by MVCC) to be given to the person/family claiming the body. 8. In the event no family member or person claims the cremated remains, the successful bidder shall be responsible for burial or storage of the cremains. The successful bidder will devise a method of storage of such cremains in a manner approved by MVCC (a description of these methods shall be included with the bid proposal). 9. No other services are to be provided for cremation funerals, including, but not exclusively, caskets, visitations/viewings, memorial services, or graveside services. Page 5

CONTRACT TERM The contracts for the provision of these services will be for a term of two years, with the option of a mutually agreed-upon extensions for a third year and a fourth year. BOND REQUIREMENTS BID BOND Each bidder shall submit a bid bond on the provided form, or a certified check, in an amount equal to ten percent (10%) of the total estimated cost of twenty-five (25) indigent funerals. PERFORMANCE BOND The successful bidder shall provide a performance bond in a form acceptable to the contracting entity, to each participating municipality in an amount equal to 100% of the cost of twenty (20) indigent funerals. CONTACT INFORMATION: For additional information concerning this request for bids, please contact Brian Humphress, Executive Director Miami Valley Communications Council 1195 East Alex-Bell Road Centerville, OH 45459 Phone: 937-424-1660 Fax: 937-438-8569 Email: bhumphress@mvcc.net Page 6

2015 INDIGENCE GUIDELINES FOR THE MVCC INDIGENT FUNERAL PROGRAM Persons in family/household Indigence guideline For families/households with more than 8 persons, add $6,320 for each additional person. 1 $17,655 2 23,895 3 30,135 4 36,375 5 42,615 6 48,855 7 55,095 8 61,335 Page 7

MVCC INDIGENT FUNERAL PROGRAM APPLICATION Date: Deceased: Time: Social Security # Address: If care facility/previous address: Death Date: Place of Death: Date of Birth: Employment: Benefits Available: Yes No Veteran: Yes No Deceased Income Source & Amount: Surviving Spouse: Yes No Name: Address: Applicant Name: Relationship: Address: Phone: Applicant Employment: Applicant Income Source & Amount: Other Household Income Source & Amount: Does applicant/family wish to have the remains of the deceased after cremation: Yes No The undersigned, having been first duly sworn, states as follows: 1. The undersigned applicant gives this affidavit pursuant to R.C. 9.15 (indigent burials); 2. The body of the deceased was a legal resident of one of the following municipalities: Centerville, Germantown, Kettering, Miamisburg, Moraine, Oakwood, Springboro, or West Carrolton. 3. No burial assistance is available from any other source. 4. The deceased had no income other than that noted above, prior to his/her death. 5. The applicant/family herein has no income other than that noted above. 6. There are no insurance proceeds payable to the estate of the deceased and/or the applicant and/or any family member herein except: Page 8

Applicant s Signature SWORN TO BEFORE ME and subscribed in my presence this day of 20. (SEAL) Notary Public Page 9

BIDDERS PROPOSAL MVCC INDIGENT FUNERAL COOPERATIVE BID Submitted by: Having read the specifications for the MVCC Indigent Funeral Program cooperative bid by members of the Miami Valley Communications Council, and having also taking into account any and all addenda issued, the undersigned hereby proposes to furnish all materials and to perform all labor, as specified and described in said specifications for the said work for the following sum: A. COST INFORMATION ITEM OF WORK QUANTITY UNIT COST TOTAL COST Indigent cremations 25/year $ $ Cremains storage Unknown $ (Describe method to be used): Attach description and photo of urn to be used in the indigent funeral. B. STATEMENT BY ALL BIDDERS The receipt of the following addenda to the specifications is hereby acknowledged: Addendum number Date: Addendum number Date: C. CONTRACT PERPARATION INFORMATION: This following information is needed in order to prepare a contract for the successful bidder: Name of bidding organization: Address: Federal ID number: Fax number: Page 10

Email address: E. EXECUTION OF PROPOSAL This proposal submitted by: (name of contacting organization) Signature and title of authorized representative: Date: Name and phone number of contact person: Page 11

PROPOSAL FORM OFFER, as a Contractor authorized to do business in the State of Ohio, proposes to perform the work identified as: Miami Valley Communications Council, 2006 To: The Miami Valley Communications Council: GENTLEMEN: The undersigned hereby declares, as a bidder, that he has personally examined the site of the herein proposed work, that the only persons or parties interested in this proposal(s) are those named herein, that this bid is made without any connection with any other person making a bid for the same purpose, that he has read the Invitation to Bid, including Instructions to Bidders, General Conditions, Agreement, Bond Forms, Specifications, Plans and Drawings, and the amendments thereto, that he agrees to all of the stipulations therein contained, and he proposes and agrees that if his bid, as submitted in the attached schedule is accepted, he will contract in the form specified in the Invitation to Bid, perform all the work mentioned in the Invitation to Bid and complete the same within the time therein specified after the date of notification by the City to proceed with the work, and will furnish the required bonds all within ten days after the date of mailing Notice of Acceptance to him at his address as given below, and that he will accept in full payment therefore the prices named in the attached schedule. Said prices are to include and cover the furnishing of all material, labor, tools, equipment and all other things necessary to complete the entire work in a proper and workmanlike manner according to the plans identified in the Invitation to Bid and upon the terms and conditions and in the manner set forth in the Invitation to Bid, and under penalty of bond hereto attached, and to the full satisfaction and acceptance by the participating municipality. The following is the name and place of the surety company which will sign the bonds each in the amount of 100% of the bid as surety if the work is awarded to the undersigned. Of Local Agent Address It is hereby agreed that the Miami Valley Communications Council has the right to reject this proposal, or to award the above described work to the undersigned at the prices stipulated. If the proposal is rejected, then the enclosed check for 10% of the amount of the bid, (if a bid bond is not included), which is made payable to the Miami Valley Communications Council shall be returned to the undersigned as provided in Instruction to Bidders. (2) Page 12

If the proposal is accepted and the work is awarded and the Undersigned shall fail to enter into a Contract in the form and terms set out in the Invitation to Bid within ten days after the award shall have been made, then the said check shall be cashed and the amount thereof paid into the Treasury of the Miami Valley Communications Council as liquidated damages for the failure of the undersigned to comply with the terms of this proposal. Name of Corporation Submitting Bid Name of Partnership Submitting Bid If Partnership, Name of Partners Name of Individual Submitting Bid If Individual, Name of Business Page 13

AFFIDAVIT STATE OF OHIO ) & COUNTY OF ), BEING DULY CAUTIONED AND SWORN, STATES AS FOLLOWS : 1. That he/she is of (Title) (Name of Contracting Agency) 2. That is not presently (Name of Contracting Agency) charged with any delinquent personal property taxes on the general tax list of personal property of any county in which this taxing district has property. This taxing district includes property within the following counties: - OR 3. That is charged (Name of Contracting Party) With delinquent personal property tax on the general tax list of personal property of any county in which this taxing district has property. The taxing district includes property within the following counties: A. The amount of delinquent personal property tax due and unpaid including Any due and unpaid penalty and interest is : $ Affiant Sworn to and subscribed in my presence this day of 2006 Notary Public NOTE TO FISCAL OFFICER: If any personal property taxes are delinquent, you must send a copy of this statement to the County treasurer within 30 days of the date it is submitted. Page 14

CERTIFICATE OF NON-COLLUSION INDIGENT FUNERAL PROGRAM MIAMI VALLEY COMMUNICATIONS COUNCIL STATE OF OHIO AFFIDAVIT The undersigned, of lawful age, being first duly sworn, deposes and says: That as a condition precedent to the award of the Miami Valley Communications Council project as above captioned: I (owner) (partner) (officer or delegate) of (firm) do solemnly swear that neither I, nor to the best of my knowledge, any member or members of my firm or company have either directly or indirectly restrained free and competitive bidding on this project by entering into any agreement, participating in any collusion, or otherwise taking any action unauthorized by the Miami Valley Communications Council. Contractor By Subscribed and sworn to me before this day of, 2015 Seal Expires : Notary Public Page 15

CERTIFICATE OF NON-DISCRIMINATION INDIGENT FUNERAL PROGRAM MIAMI VALLEY COMMUNICATIONS COUNCIL STATE OF OHIO AFFIDAVIT The undersigned, of lawful age, being first duly sworn, deposes and says: That as a condition precedent to the award of the pavement marking bid as above captioned: I of (owner) (officer or delegate) (firm) (partner) do solemnly swear that neither I, nor to the best of my knowledge, any member or members of my firm or company will discriminate against any employee or applicant for employment because of race, religion, color, sex, ancestry, age, handicap or national origin. I will take affirmative action to assure that applicants are employed, and that employees are treated during employment without regard to their race, religion, color, sex, ancestry, age, handicap or national origin. Such action shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoffs or terminations; rates of pay or other forms of compensation; and selection for training, including apprenticeship. I agree to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. I will, in all solicitations or advertisements for employees placed by or on behalf of myself, state that all qualified applicants will receive consideration for employment without regard to race, religion, color, sex, ancestry, age, handicap or national origin. I will send to each labor union or representative of workers with which I have a collective bargaining agreement or other contract of understanding a notice advertising the labor union or workers representative of my commitments and shall post copies of the notice in conspicuous places available to employees and applicants for employment. In the event of my noncompliance with the non-discrimination clauses of this contract or with any of such rules, regulations or orders, this contract may be terminated in whole or in part as set forth in the clause entitled Termination for Default. Contractor By Subscribed and sworn to me before this day of, 2015 My Commission Expires : Notary Public Page 16

BID BOND KNOW ALL MEN BY THESE PRESENTS, That we, Principal and as Surety, are held and firmly bound unto the Miami Valley Communications Council, State of Ohio, hereinafter called MVCC, in the penal sum of dollars 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 has submitted the accompanying bid, this day of 2015, for satisfactory Bid Bond submitted as per attached copy, covering the following project: Indigent Funeral Program. NOW, THEREFORE, if the principal shall not withdraw said bid within the period specified therein after the opening of the same, or if no period be specified, within sixty (60) days after said opening, and shall within the period specified therefore, or, if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the City in accordance with the bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such contract, or in the event of the withdrawal of said bid within the period specified, or the failure to enter into such contract and give such bond within the time specified, if the principal shall pay the City the difference or failure to enter into such contract and give such bond within the time specified, if the principal shall pay the City the difference between the amount specified in said bid and the amount for which the City may procure the required work and/or supplies if the latter amount be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue. IN WITNESS WHEREOF, the above-bound parties have executed this instrument. Under their several seals this day of 2015, and name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative. Two Witnesses (if individual). Principal BY ATTEST: (If corporation) Corporate Seal Title Surety Alternative: Certified check in the amount of 10% of bid, payable to the Miami Valley Communications Council. Page 17

BIDDER S PRINCIPALS EXPERIENCE AND REFERENCE PRINCIPALS The full names and residences of persons and firms interested in the foregoing Bid as Principals are as follows: EXPERIENCE AND REFERENCES Page 18