REQUEST FOR PROPOSALS
For the Removal and Installation of Video and Audio Surveillance
Cameras
Issued by:
The City of Sandusky, Ohio
Issued:
June 24, 2013
Contact Person:
John Orzech, Chief of Police
City of Sandusky Police Department
222 Meigs Street
Sandusky, OH 44870
Phone: (419) 627-5869
Fax: (419) 627-5962
email: jorzech@ci.sandusky.oh.us
Proposals Due:
July 15, 2013 at 2:00 p.m.
The City of Sandusky reserves the right to reject any or all Proposals, to waive informalities, or to
accept any Proposal which it deems most favorable to the City of Sandusky
Page 1 of 21
Section
Table of Contents
Page
I.
Notice to Proposers --------------------------------------------------------------------------------------------- 3
II.
Specific Timeline
4
III. Instruction to Proposers ----------------------------------------------------------------------------- 4
IV. Communications and Questions Concerning Proposal ---------------------------------- 5
V.
Scope of Service and Specifications --------------------------------------------------------------------- 6
VI.
Proposal Submittal and Format ---------------------------------------------------------------------------- 7
VII. Interpretation ----------------------------------------------------------------------------------------------------- 8
VIII. Proposal Evaluation Criteria -------------------------------------------------------------------------------- 9
IX.
Key Elements of a Proposer's Proposal Concerning Qualifications and
Experience to be Furnished to the City --------------------------------------------------------------- 11
X.
Bid Protest Procedures ------------------------------------------------------------------------------------ 11
Page 2 of 21
SECTION I. NOTICE TO PROPOSERS
LEGAL NOTICE
REQUEST FOR PROPOSALS
Sealed proposals will be received by the City of Sandusky in the Sandusky Police Department, 222
Meigs Street, Sandusky, OH 44870 UNTIL Monday, July 15, 2013 AT 2:00 P.M. (EST) to remove
existing video surveillance cameras, cable, and hardware and to provide labor, material and
equipment for the installation of a new video surveillance system with audio capabilities in order to
provide comprehensive security coverage of entrances, and specific interior and exterior areas at
the Sandusky City Building and the Sandusky Police Department facilities. The City of Sandusky
intends to execute a Purchase Agreement with a responsible bidder who, in the sole discretion of
the City, proposes the lowest and best bid.
All proposals shall be submitted in a sealed envelope clearly labeled “Video Surveillance System for the
Sandusky City Building and Sandusky Police Department Facilities.” The name and address of Proposer
shall also appear on the outside of the envelope.
The Request for Proposals (RFP) will be available for pick up in the City of Sandusky Police Department,
222 Meigs Street, Sandusky, Ohio 44870 on June 24, 2013 and shall also be available to download on the
City of Sandusky’s website at www.ci.sandusky.oh.us .
Sealed Proposals will be received by the City of Sandusky, in the City of Sandusky Police Department and
shall be addressed to the “Chief of Police, 222 Meigs Street Sandusky, Ohio 44870.” Proposals shall be
delivered NO LATER THAN Monday, July 15, 2013 at 2:00 P.M. (EST) .
All Proposals must be received on time and in full compliance with the instructions contained in the RFP.
The City of Sandusky reserves the right to reject any or all proposals, to waive informalities, to accept any
Proposal which it deems most favorable to the City of Sandusky and to withdraw this solicitation at any time.
Approved for publication
By:
CITY OF SANDUSKY, OHIO
John Orzech, Chief of Police
DATES OF PUBLICATION: June 24, 2013 and July 1, 2013
Page 3 of 21
SECTION II. SPECIFIC TIMELINE
June 24 and July 1, 2013 – Legal notice published in the Sandusky Register that the City of Sandusky is
accepting Proposals for the installation of a new video surveillance system at the Sandusky City
Building and the Sandusky Police Department facilities and the Request for Proposals packets are
available.
Wednesday, July 3, 2013, 2:00 P.M. (EST) – Mandatory Pre-Proposal Meeting to be held in the Sandusky
Police Department, 222 Meigs Street, Sandusky, Ohio 44870.
Friday, July 5, 2013 at 5:00 P.M. (EST) – The last day to submit questions and clarifications regarding this
Request for Proposals.
Tuesday, July 9, 2013 at 3:00 P.M. (EST) – Questions and clarification regarding this Request for
Proposals shall be answered.
Monday, July 15, 2013 at 2:00 P.M. (EST) – Deadline for submittal of Proposals to the City of Sandusky.
Friday, July 26, 2013 – Latest anticipated date that the City of Sandusky shall notify Proposers of the intent
to enter into a contract.
SECTION III. INSTRUCTIONS TO PROPOSERS
This Request for Proposals is being issued by the City of Sandusky. Primary contact for all communications
regarding this Request for Proposals shall be the Chief of Police, John Orzech, 419-627-5869.
All private, for-profit, non-profit and public entities shall be eligible to submit Proposals for this work.
A notice regarding this Request for Proposals shall be published as a legal notice in the Sandusky Register.
This Request for Proposals shall be available for pick up on June 24, 2013 in the City of Sandusky Police
Department, 222 Meigs Street, Sandusky, Ohio 44870 and shall be available to download from the City of
Sandusky’s website at www.ci.sandusky.oh.us.
Sealed Proposals will be received by the City of Sandusky at the Sandusky Police Department and shall be
addressed to the “Chief of Police, 222 Meigs Street, Sandusky, Ohio 44870”, until Monday, July 15, 2013 at
2:00 p.m. Any Proposal received after that date and time shall be considered non-responsive and shall be
returned to the respondent unopened.
Proposer bears total responsibility for ensuring their Proposal is complete and arrives on time.
Proposals received by fax or email will not be considered.
Proposers shall comply with each and every requirement of this RFP to be considered responsive.
In order to be considered responsive, all Proposers shall complete and submit with their Proposal the
Proposer Questionnaire, Waiver and Release Form, Disclosure of Personal Property Taxes, No Unresolved
Finding of Recovery Issued by the Auditor of the State of Ohio and the Non-Collusion Affidavit, attached on
pages 14 – 22 of this Request for Proposals.
A selection committee will review and evaluate each Proposal.
Page 4 of 21
The City of Sandusky intends to execute a Purchase Agreement with a responsible Proposer who, in the
sole discretion of the City, submits the lowest and best bid.
The City of Sandusky reserves the right to reject any or all Proposals, to waive informalities, to accept any
Proposal which it deems most favorable to the City of Sandusky and to withdraw this solicitation at any time.
SECTION IV. COMMUNICATIONS AND QUESTIONS CONCERNING PROPOSALS
1) Mandatory Pre-Proposal Meeting and Walk-Through
A mandatory Pre-Proposal Meeting shall be held on Wednesday, July 3, 2013 at 2:00 P.M. (EST) in the
Sandusky Police Department located at 222 Meigs Street, Sandusky, Ohio 44870. The mandatory PreProposal Meeting shall be for the purpose of viewing and discussing installation locations and for
clarification and/or correction of the Request for Proposals, including any revisions, and to assure
understanding of and responsiveness to the requirements, terms and conditions, and specifications of
the Request for Proposals. A walk-through of the facilities will follow the mandatory Pre-Proposal
Meeting. A limit of two representatives per company will be able to attend the walk-through in order to
keep interruptions of daily operations to a minimum. All Proposers shall be afforded fair and equal
treatment and any questions, clarifications or amendments to this Request for Proposals resulting from
the mandatory Pre-Proposal Meeting shall be distributed to those entities in attendance at such meeting.
Responses to oral inquiries at the mandatory Pre-Proposal Meeting shall be based on the information
provided in the Request for Proposals. All statements made in writing, including responses to the
mandatory Pre-Proposal Meeting shall supersede any oral statements.
2) Questions, Amendments, and Clarifications
Questions or clarifications regarding the RFP shall be directed in writing, by email or fax to:
John Orzech, Chief of Police
Sandusky Police Department
222 Meigs Street
Sandusky, OH 44870
Phone: (419) 627-5869
Fax: (419) 627-5862
email: jorzech@ci.sandusky. oh.us
The final date and time for inquires regarding the Request for Proposals shall be Friday, July 5, 2013 at
5:00 P.M. (EST).
Answers to questions and clarifications shall be distributed on Tuesday, July 9, 2013 at 3:00 p.m. to all
entities that were in attendance at the mandatory Pre-Proposal meeting.
John Orzech, Chief of Police, is the contact person at the City for questions regarding this Request for
Proposals. The City shall not be responsible in any manner for verbal answers or instructions regarding
this Request for Proposals.
If it becomes evident that the Request for Proposals must be amended, the City of Sandusky will issue a
formal written amendment to all known prospective Proposers.
Page 5 of 21
The Request for Proposals, and any addendums and amendments issued by the City, and the
Proposals, with incident and accompanying Proposal Submittal Forms submitted by the Proposer, shall
constitute the entire agreement between the City and the successful Proposer. There shall be no verbal
agreements.
3) Withdrawal of Proposal
Sealed proposals may be withdrawn prior to the opening of the proposals in person by a Proposer or
his/her authorized representative, by signing a receipt for the proposal.
SECTION V. SCOPE OF SERVICES AND SPECIFICATIONS.
1) Statement of Purpose
The City of Sandusky seeks to enter into a contract with a qualified Proposer to remove existing video
surveillance cameras, cable, and hardware and to provide labor, material and equipment for the
installation of a new video surveillance system with audio capabilities in specific locations in
order to provide comprehensive security coverage of entrances, and specific interior and
exterior areas at the Sandusky City Building and Sandusky Police Department facilities which
shall include, but not be limited to the provision of design, equipment, software, installation, training,
maintenance and technical support.
The Sandusky City Building facility is generally open to the public Monday through Friday from 7:00 a.m.
until 5:00 p.m. and is utilized after 5:00 p.m. for meetings of the Sandusky City Commission and other
various commissions and committees that hold meetings that are open to the public. The Sandusky
Police Department facility is open 24 hours and has limited access to the public due to the confidential
and sensitive nature of law enforcement investigations and other safety and security concerns that are
common to law enforcement operations. The video surveillance system is necessary for the protection
of the employees of the City of Sandusky and the general public that may inhabit the facilities.
The City of Sandusky has issued this RFP to define the minimum service requirements; solicit
proposals; detail proposal requirements; and outline the City’s process for evaluating proposals and
selecting the successful Proposer.
Through this RFP, the City seeks to buy the best services and equipment at the most favorable,
competitive prices and to give qualified businesses an equal opportunity to do business with the City of
Sandusky.
2) Scope of Work
The Proposer shall remove a total of 15 video cameras, including audio systems, cables, and hardware
that are currently in place at the Sandusky City Building and the Sandusky Police Department facilities.
The Proposer shall provide a new comprehensive video surveillance system that shall provide video
coverage of the Sandusky City Building and the Sandusky Police Department facilities in the areas
depicted on the Site Map attached to this RFP marked as “Exhibit A”, as well as provide audio
capabilities to the specified areas labeled on the map. All DVRs and Personal Computers (PCs)
providing coverage of the Sandusky City Building facility shall be on a 10.x.x.x network and all DVRs
and PCs providing coverage of the Sandusky Police Department facility shall be on a 192.x.x.x network.
Page 6 of 21
The Proposal shall include all equipment, installation, training and maintenance to provide a high quality,
fully operational video surveillance system that shall include, but may not be limited to the following:
a.) As many video surveillance cameras as needed to effectively provide video surveillance coverage
as depicted on the Site Map attached to this RFP marked as “Exhibit A”. All exterior cameras shall
have night recording capabilities.
b.) A minimum of two (2) Digital Video Recorders (DVRs):
1. One (1) that shall provide coverage of the Sandusky City Building facility connected to a
10.x.x.x network; and
2. One (1) that shall provide coverage of the Sandusky Police Department facility connected to a
192.x.x.x network.
c.) Date and time scheduling options with date/time stamp.
d.) All necessary monitors, transmitters, receivers, power supplies and wireless motion sensors.
e.) Any environmental controls required for exterior cameras including heaters, blowers, etc.
f.) Cabling and cross connections to provide complete connectivity from camera locations to monitors,
transmitters, receivers and DVRs.
g.) Jacks, connectors, ties, clamps, conduit and any other hardware as needed to install all proposed
equipment.
h.) Racks and hardware for mounting equipment and wiring in accordance with final design
specifications.
i.) Video management software with web-based remote access that is compatible with Windows.
j.) Unlimited client licenses permitting monitoring of live and playback video, so that video
management software may be installed at no extra cost on any device that requires access to
remote viewing as determined by the Chief of Police.
k.) Cameras shall be high quality with sufficient resolution and clarity for positive visual identification of
recorded subjects that shall be suitable to be presented as evidence in a court of law.
l.) The video surveillance system, including the audio component, shall have the necessary storage
capacity to recall and produce video and audio data for a minimum of twenty one (21) days.
m.) A one (1) year warranty on all parts and labor, a one (1) year maintenance agreement, and
technical support for a period of at least one (1) year that will commence at the completion of
training and shall include over-the-phone and site visits as needed at no additional charge .
Proposer shall also include a fixed yearly cost quote for extended warranty, maintenance and
technical support with an option to renew annually for an additional four (4) years.
The Proposer shall also provide:
a.) Final aiming, focusing, and proper adjustment of all cameras.
b.) Programming of DVRs to include camera names, user/operator data and permissions, basic
recording settings, remote access settings, and other programming as needed to make the video
surveillance system, including the audio component, fully operational.
c.) On-site training for client users in accordance with client work schedules.
d.) A list of additional options or recommendations not specified in this RFP.
3) Background Check
Successful Proposer shall be required to submit to the Chief of Police for security approval a current BCI
Criminal Background check for each employee or contractor that will require access to the Sandusky
City Building and the Sandusky Police Department facilities.
Page 7 of 21
SECTION VI. PROPOSAL SUBMITTAL AND FORMAT
The Request for Proposals (RFP) will be available for pick up in the City of Sandusky Police Department,
222 Meigs Street, Sandusky, Ohio 44870 on Monday, June 24, 2013 and shall also be available for
download on the City of Sandusky’s website at www.ci.sandusky.oh.us.
Sealed Proposals will be received by the City of Sandusky in the Sandusky Police Department and shall be
addressed to the “Chief of Police, 222 Meigs Street Sandusky, Ohio 44870”, until Monday, July 15, 2013 at
2:00 p.m. when all proposals shall be opened and made public. The public opening is for informational
purposes only and is not to be construed as an acceptance or rejection of any proposal. Proposals
submitted will be evaluated as indicated in Section VIII. No proposal shall be considered if it arrives after
the time set for opening as determined by the employee of the City designated to open the proposals.
The City of Sandusky reserves the right to reject any or all proposals, to waive informalities, to accept any
proposal which it deems most favorable to the City of Sandusky and to withdraw this solicitation at any time.
Proposer bears total responsibility for ensuring their proposal is complete and arrives on time.
Proposals received by fax or email will not be considered.
Proposer shall comply with each and every requirement of this Request for Proposals to be considered
responsive.
All original signatures shall be in BLUE OR BLACK ink. If space provided is insufficient for response, attach
additional sheets to the forms, clearly referencing such sheets back to specific points addressed in the
forms.
This Request for Proposals by the City does not constitute an offer by the City and, likewise, proposals
made by interested Proposers to the City are not acceptances. After negotiation of a mutually satisfactory
final form of contract between the City and a Proposer, approval of such contract by the City Commission of
the City of Sandusky and full execution thereof, the parties will then be legally bound in accordance with the
terms and provisions of the contract. Selection of one or more Proposers for the purpose of entering into
preliminary negotiations does not obligate the City to enter into a contract.
Any costs incurred by interested Proposers in preparing responses to the City's Request for Proposals and
in carrying out negotiations with the City are the sole responsibility of the Proposer and not the City.
The City reserves the right to request such additional and supplemental information from interested
Proposers as the City believes is necessary and appropriate to accomplish the City's objectives.
In order to be considered responsive, Proposer shall complete and submit with their proposal the Proposer
Questionnaire, Waiver and Release Form, Disclosure of Personal Property Taxes, No Unresolved Finding of
Recovery Issued by the Auditor of the State of Ohio and the Non-Collusion Affidavit, attached on pages 14 –
22 of this Request for Proposals.
The City of Sandusky reserves the right to reject, in whole or in part, any and all proposals where the City in
its sole discretion, taking into consideration the results of the evaluation process, has determined that award
of a contract would not be in the best interest of the City.
Page 8 of 21
SECTION VII. INTERPRETATION
If any Proposer finds any perceived ambiguity, conflict, error, omission or discrepancy between any of the
documents contained in this Request for Proposals, the Proposer shall submit a written request no later
than ten (10) days prior to July 15, 2013.
Requests should be directed to:
John Orzech, Chief of Police
Sandusky Police Department
222 Meigs Street
Sandusky, OH 44870
Phone: (419) 627-5869
Fax: (419) 627-5862
email: jorzech@ci.sandusky. oh.us
If the Chief of Police determines an interpretation or clarification is warranted, the Chief of Police shall issue
an addendum and provide a copy to each Proposer of record.
Any interpretation or clarification of the documents contained in this Request for Proposals made by any
person other than the Chief of Police, or in any manner other than a written addendum, shall not be binding
and the Proposer shall not rely upon any such interpretation or clarification.
If any addendum is issued within 96 hours prior to the published time for the opening of the Request for
Proposals, excluding Saturdays, Sundays and legal Holidays, the opening of the Request for Proposals
shall automatically be extended one (1) week, with no further advertising required.
SECTION VIII. PROPOSAL EVALUATION CRITERIA
A Selection Committee intends to review the proposals received by the City. The City reserves the right to
make such follow-up requests for additional and supplemental information as the City determines necessary
and intends to select one or more Proposers for the purposes of preliminary negotiations. The City intends
that such preliminary negotiations will be focused on the ability of the City and any such Proposer to
negotiate a mutually satisfactory form of contract for the removal and installation of the video surveillance
system at the Sandusky City Building and the Sandusky Police Department facilities. If a proposed final
form of a contract is negotiated it would then be submitted to the Sandusky City Commission for its
approval.
Based upon the City's review of the information contained in the proposals and such additional and
supplemental information as the City may request, the City intends to select one or more Proposers for the
purpose of entering into preliminary negotiations. Based upon such preliminary negotiations, the City
intends to select a Proposer to negotiate a mutually satisfactory form of contract. Such Proposer selections
will be based on the City's sole determination which will include consideration of the following Evaluation
Criteria:
Page 9 of 21
EVALUATION CRITERIA
EVALUATION
FACTORS
MAX
POINTS
SCORE
Understanding (Proposer has
demonstrated a thorough
understanding of the scope of
the project and their role and
responsibilities in performing
the services required.)
20
_______
_______
_______
Experience (Experience of the
Proposer with installing and
implementing similar video
surveillance systems and previous
performance record.)
20
_______
_______
_______
System Design (Ability to meet
the City’s objectives.)
20
_______
_______
_______
Service Plan
(Proposer has created a
comprehensive plan that includes
system design, employee training,
warranties, maintenance, and technical
support.)
20
_______
_______
_______
Quality of Equipment
(Use of familiar brand names, terms
of warranty and service.)
20
_______
_______
_______
“User Friendly”
(Ease of use in downloading and
extracting data, programming,
training, etc.)
20
_______
_______
_______
Proposer’s Financial Capacity
20
_______
_______
_______
Cost (Proposed cost appears
complete, realistic, and economically
viable.)
20
_______
_______
_______
Presentation and Proposal
(Proposal is organized and
responsive to all areas contained
in the RFP; Proposer exhibited
confidence and knowledge
regarding the proposed
video surveillance system.)
10
_______
_______
_______
_______
_______
_______
150
40
190
TOTAL
Total Possible Points
Page 10 of 21
+
QUALITY
LEVEL =
TOTAL
SCORE
Quality level shall be based upon the following scoring method:
Quality Level
Points
Description
Excellent
5
Meets all requirements; reflects significant
enhancements or strengths as compared to
minimum levels of acceptability; no
offsetting weaknesses.
Very Good
4
Meets all requirements; reflects some
enhancements or strengths; few if any
offsetting weaknesses.
Good
3
Meets all requirements; strengths and
weaknesses, if any tend to offset each
other equally.
Fair
2
May contain significant weaknesses only
partially offset by less pronounced
strengths; should meet all minimum
requirements, but some areas of doubt
may exist.
Poor
1
Serious doubt exists about ability to meet
minimum needs, but may be sufficient;
significant weaknesses without offsetting
strengths.
Deficient
0
Will not meet minimum needs.
SECTION IX. KEY ELEMENTS OF A PROPOSER'S PROPOSAL CONCERNING QUALIFICATIONS
AND EXPERIENCE TO BE FURNISHED TO THE CITY
(A) An interested Proposer should supply such necessary site plan, floor plan, renderings, other illustrative
materials, and such narrative as is useful to describe the proposed removal of existing video
surveillance cameras, cable, and hardware and the installation of a new comprehensive video
surveillance system that shall provide video coverage of the Sandusky City Building and the Sandusky
Police Department facilities in the areas depicted on the Site Map attached to this RFP as Exhibit A, as
well as provide audio capabilities to the specified areas labeled on the map. Proposers is are
encouraged to use their imagination, creativity, and business and marketing judgment to make
specific recommendations to the City for the successful design and implementation in addition to
providing specific steps to be taken to accomplish the installation and implementation. Proposer shall
provide an itemized breakdown of all costs.
(B) The City requests that interested Proposers provide information to the City concerning the Proposer, its
qualifications and experience, references (including names and telephone numbers), and experience in
comparable projects. Information is also requested concerning the Proposer's management team and
Page 11 of 21
proposed manager of that team and the principals of the Proposer including background and
biographical.
(C) The City requests information from each interested Proposer concerning the Proposer's financial
capacity including the most recent financial statements for the Proposer.
(D) The City will seek to maintain confidentiality among each interested Proposer with respect to the
information received from each interested Proposer. As in the case with other Ohio cities, the City is
subject to Ohio's Public Records Law. Accordingly each interested Proposer should operate under the
assumption that written information provided to the City will be a public record available for inspection
upon request by members of the general public.
Page 12 of 21
CITY OF SANDUSKY, OHIO
PROPOSER'S QUESTIONNAIRE
In additional to responding to the requests for information set out in Section IX. of the
Request for Proposals, each interested Proposer shall also provide the following specific
information with respect to the Proposer, its qualifications and financial responsibility.
1.
(A)
Name of Proposer:
(B)
Address of Proposer:
(C)
Name, address and telephone number of contact person:
2.
Describe the Proposer's form of business organization (corporation, partnership, etc.):
3.
If the Proposer is a subsidiary of or affiliated with any other corporation or business entity,
please list each such other business entity by firm name and address, and specify its
relationship to the Proposer:
4.
Has the Proposer or (if any) its parent or affiliated company been adjudged bankrupt, either
voluntary or involuntary, or filed bankruptcy proceedings, within the past ten (10) years?
Yes
No
If the answer is yes, please provide and attach history and explanatory information.
Page 13 of 21
5.
Has any officer, director or principal of the Proposer or of its parent or affiliated company
been indicted for or convicted of any felony?
Yes
No
If the answer is yes, please provide and attach explanatory information, including the
charge, place, court, date, and action taken and attach any explanation appropriate.
6.
State whether the Proposer or its parent or affiliated company has within the last ten (10)
years engaged in litigation concerning a business or management contract.
Yes
No
If yes, please provide and attach explanatory information.
7.
Does any member of the City Commission of the City of Sandusky, or any other officer or
employee of the City of Sandusky, have any direct or indirect personal interest in the
Proposer, or in its parent or affiliated company?
Yes
No
If yes, please provide and attach explanatory information.
8.
Is any former officer or employee of the City of Sandusky employed by the Proposer or by
its parent or affiliated company?
Yes
No
If yes, please provide information concerning such former officer or employee, date of
employment and responsibility within the company.
9.
Does the Proposer or its parent or affiliated company owe:
(a)
Any delinquent taxes to the State of Ohio, a State agency, or any political division
of the State?
Yes
(b)
Any moneys to the State or any State agency for the administration or enforcement
of the environmental laws of the State?
Yes
(c)
No
No
Any other moneys to the State, a State agency or any political subdivision of the
State that are delinquent?
Yes
No
Page 14 of 21
(d)
Any delinquent taxes for which the Proposer or its property, or its parent or
affiliated company or its property, are the subject of any existing tax lien?
Yes
No
As to any of the above which are answered yes, please provide and attach details and
explanatory information to this questionnaire.
10.
Has the Proposer or its parent or affiliated company, or any officer, director or principal
thereof:
(a)
Been indicted for or convicted of or enjoined from any violation of State or Federal
securities law?
Yes
(b)
No
Been a party to any consent order or entry with respect to an alleged State or
Federal securities law violation?
Yes
No
As to any of the above which are answered yes, please provide and attach explanatory
information to the questionnaire.
CERTIFICATION
The undersigned hereby certifies that the Proposer's Questionnaire and any attached explanatory
information is true and correct to the best of my (our) knowledge and belief.
Proposer:
By:
Title:
Address:
City, State:
Telephone No.:
Fax No.:
Page 15 of 21
WAIVER AND RELEASE FORM
In consideration of the review by the City of Sandusky, Ohio, of a contract proposal and bid
submitted by the undersigned, and as a condition precedent thereto, the undersigned does hereby
authorize and direct the release to administrative officers of the City any and all information related
to the current obligations of the undersigned to the City, including, but not by way of limitation,
obligations under the City's income tax, hereby waiving any privilege, statutory or otherwise, as to
the same, and releasing the City of Sandusky, Ohio, its officers, agents, and employees from any
liability in relation thereto.
_________________________________________________
Signature
Sworn
to
and
subscribed
before
me
a
______________________________________________________
__________________________, 20____.
My commission expires: ______________
____________________________________
Notary Public
Page 16 of 21
Notary
this
Public
_________
day
by
of
DISCLOSURE OF PERSONAL PROPERTY TAXES
Ohio Revised Code 5719.042 requires a taxing district's fiscal officer to obtain a statement from
each successful bidder on any contract let by competitive bidding that the contractor has not been
charged, as of 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 taxing district has territory or that
such person 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.
After the award by a taxing district of any contract let by competitive bid and prior to the time the
contract is entered into, the person making a bid shall submit to the district's fiscal officer a
statement affirmed under oath that the person with whom the contract is to be made 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 taxing district has territory or that
such person 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.
A copy of the statement shall also be incorporated into the contract, and no payment shall be made
with respect to any contract to which this section applies unless such statement has been so
incorporated as a part thereof.
Page 17 of 21
DISCLOSURE OF PERSONAL PROPERTY TAXES
STATE OF OHIO
COUNTY OF _________________________
)
) SS:
)
The undersigned being first duly cautioned and sworn says that he is the
________________________________________ of ________________________________________
Name
Company Name (If applicable)
who made a bid for an improvement project or for the purchase of services and supplies for the City of
Sandusky, Ohio, involving the competitive bid process;
That Affiant says that he is familiar with Section 5719.042 of the Ohio Revised Code and that he
submits to the City of Sandusky Finance Director as the Taxing District Fiscal Officer this statement affirmed
under oath that as the person with whom the bid was submitted that the contractor has not been charged,
as of 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 taxing district shown as the City of Sandusky has territory or
that such person was charged with delinquent personal property taxes on any such tax list;
(Strike out if not applicable) This statement sets forth in full, the amount of such due and unpaid
delinquent taxes and any due and unpaid delinquent taxes and any due and unpaid penalties and interest
thereon as specified by Section 5719.042 by Exhibit "A" which is attached hereto and made a part hereof
this Affidavit as if fully rewritten and is incorporated by reference;
The Affiant says that if this statement indicates that the taxpayer was charged with any such taxes,
a copy of the statement shall, with the permission of the taxpayer, which is hereby given, be transmitted by
the Finance Director of the City of Sandusky to the County Treasurer within thirty (30) days of the date this
statement is submitted.
Affiant further says that a copy of the statement shall also be incorporated into the contract with the
City of Sandusky and agrees that no payment shall be made with respect to any contract to which Section
5719.042 Revised Code applies unless such statement has been so incorporated as a part thereof.
_________________________________________________
Affiant Signature
Sworn to and subscribed before me a Notary Public by _____________________________this _________
day of _____________________, 20____.
My commission expires: ______________
____________________________________
Notary Public
Page 18 of 21
EXHIBIT A
At the time I submitted my bid I was charged with delinquent personal property taxes, penalties and interest
as follows:
$_________________________________ Delinquent Taxes
$_________________________________ Penalties
$_________________________________ Interest
________________________________________
Name
________________________________________
Company
________________________________________
Signature
Page 19 of 21
OHIO REVISED CODE SECTION 9.24 – NO UNRESOLVED FINDING OF RECOVERY ISSUED
BY THE AUDITOR OF THE STATE OF OHIO
The UNDERSIGNED PROPOSER/CONTRACTOR certifies, to the best of his or her knowledge
and belief, pursuant to Ohio Revised Code Section 9.24, there is no unresolved finding of recovery
issued by the auditor of the State of Ohio pending against it.
Date: _______________________________________________________________________________
Signature: ____________________________________________________________________________
Company Name (if applicable): ___________________________________________________________
Title: ________________________________________________________________________________
Page 20 of 21
NON-COLLUSION AFFIDAVIT
STATE OF OHIO
)
)
COUNTY OF ________________ )
SS:
____________________________________________________, being first duly sworn, deposes and says
that he is __________________________________________________(Sole owner, a partner, president,
secretary, etc.) of _______________________________________________________________________,
the party making the foregoing proposal; that such proposal is genuine and not collusive or sham; that said
proposer is not financially interested in, or otherwise affiliated in a business way with any other proposer on
the same contract; that said proposer has not colluded, conspired, connived, or agreed, directly or indirectly,
with any proposer or person, to put in a sham proposal, or that such other person shall refrain from
submitting a proposal, and has not in any manner, directly or indirectly sought by agreement or collusion, or
communication on conference, with any person, to fix the proposal price of affiant or any other proposer, or
to fix and overhead, profit or cost elements of said proposal price, or that of any other proposer, or to secure
an advantage against the City, or any person or persons interested in the proposed contract and that all
statements contained in said proposal are true; and further, that such proposer has not, directly or indirectly
submitted said proposal, or the contents thereof, or divulged information or data relative thereto to any
association or to any member or agent thereof.
_____________________________________, Affiant
Sworn to and subscribed before me a Notary Public by ____________________ this _________ day of
__________________________, 20____.
My commission expires: ______________
____________________________________
Notary Public Signature
SEAL:
Page 21 of 21