Request for Proposal - Ottawa County

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Finally, I do certify that this organization is not currently involved in any state of <strong>for</strong>mal bankruptcyproceedings.Signature of Authorized Representative of Bidding EntityDateSworn to and subscribed be<strong>for</strong>e me this _day of(Notary Public)My Commission Expires:Ohio.COMPETITIVE PROPOSAL AFFIDAVtT, Poge 2
Attachment HREPRESENTATIONS, ASSURANCES, AND CERTIFICATIONS1. Company Name:2. Company Address:3. Telephone Number: FAX:4. The name and telephone number of the person(s) who has the authority to submitproposals:5. The name and telephone number ofthe person(s) who has the authority to signcontracts:6. The legal status of the bidder=s organization( e.g. corporation, sole proprietor ship,post-secondary education institution, etc. )7. Date of establishment/ incorporation:8. Federal Employer ldentification Number (FEIN):9. Worker=s Compensation Account Number:10. Unemployment Insurance Account Number:11. ls the company co-owned or controlled by a parent company? _yes Nolf yes, name of parent company:12. ls the bidder authorized/ licensed to do business in the state of Ohio? yes No13. ls the bidder bound by Federal, State, or local Affirmative Actionor Equal Employment Opportunity rules? yes Nolf yes, has the company filed all required EEO reports tothe necessary agencies? yes No
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Request for Proposal - Ottawa County

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