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Bid Book - Dublin City, Ohio

Bid Book - Dublin City, Ohio

F. AFFIDAVIT OF

F. AFFIDAVIT OF AUTHORITYCITY OF DUBLIN2013 STORM STRUCTURE MAINTENANCE PROJECT(To be completed and executed if the Contractor is anything other than a sole proprietorship.)State of _______________ (State Where Completing this Form)County of _____________ (County Where Completing this Form) ss:___________________________________ (Your Name), being duly sworn, deposes and says that heor she is the ______________________________________________________________ (Position)of __________________________________________________________________ (Business Name),a _____________________________ (Type of Entity) organized and existing under and by virtue ofthe laws of the State of _______________________________ (State), and having its principal officeat:_________________________________________________(Address), __________________ (City),_________________ (County),__________ (State).Affiant further says that he is familiar with the records, minute books and by‐lawsof___________________________________________________________________ (Business Name).Affiant further says that ___________________________________ (Name of Person Signing Contract)________________ (Title of Person Signing Contract) of ___________________________ (Business Name)is duly authorized to sign the Contract for the CITY OF DUBLIN 2013 STORM STRUCTUREMAINTENANCE Project on behalf of _______________________________________________(Business Name) by virtue of_________________________________________________________________________________.(Describe how the person signing the Contract has Authority to sign for example: “a provision of the by‐laws” or “aresolution of the Board of Directors”—if by resolution, give date of adoption.)________________________________ , __________________________ .(Your Signature)(Your Position)The foregoing instrument was acknowledged before me this ___________________________ (date)by _________________________________________________________ (name of personacknowledged). Signature and Seal of person taking acknowledgement:_________________________________________________3413‐006.0‐CIP

G. COMBINED DELINQUENT PERSONAL PROPERTY TAX & NONCOLLUSIONAFFIDAVITState of _______________ (State Where Completing this Form)County of _____________ (County Where Completing this Form) ss:____________________________________ (Your Name), Affiant, being first duly sworn, deposes and says:1. I am the ________________________________________ (Your Title) of______________________________________ (Business Name), the Bidder that has submitted the attached Bid;2. I am fully informed respecting the preparation and contents of the attached Bid and all pertinent circumstancesrespecting such Bid, and that such Bid is genuine and is not a collusive or sham Bid;4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or partiesin interest, including this affiant, has in any way colluded, conspired, connived, or agreed directly or indirectly withany other Bidder, firm, or person to submit a collusive or sham Bid in connection with the contract for which theattached Bid has been submitted, or to refrain from Bidding in connection with such contract, or has in anymanner directly or indirectly sought by agreement, collusion, communication, or conference with any otherBidder, firm, or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead,profit, or cost element of Bid price or the Bid price of any other Bidder, or to secure through any collusion,conspiracy, connivance, or unlawful agreement any advantage against the CITY OF DUBLIN, Ohio, or any personinterested in the proposed contract; and5. The price or prices quoted in the attached Bid are fair, proper, and not tainted by any collusion, conspiracy,connivance, or unlawful agreement on the part of the Bidder or any of its agent’s representatives, owners,employees, or parties in interest, including this affiant.6. Effective this _________________ day of ________________, 2013, the Bidder:ChooseOne(__)is charged with delinquent personal property taxes on the general list ofpersonal property as set forth below:County______________County______________County______________County______________CountyAmount (include total amount, withpenalties and interest thereon)$_________$_________$_________$_________(__) is not charged with delinquent personal property taxes on the general list ofpersonal property in any Ohio county.Signed: _____________________________Title:_____________________________The foregoing instrument was acknowledged before me this ___________________________ (date)by _________________________________________________________ (name of person acknowledged).Signature and Seal of person taking acknowledgement:_________ ___________________________________________3513‐006.0‐CIP

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