1-Contract Forms.pdf
PDF 66 KB Posted
- Solicitation number
- RFP-26-002 (WHR)
- Issued by
- Delaware County, Ohio
About this file
This contract forms document pertains to the City of Westerville, Ohio, and establishes the framework for proposals related to Basic Life and Accidental Death and Dismemberment (AD&D) Insurance and Short-Term Disability (STD) Administration services. The City seeks qualified vendors capable of providing comprehensive insurance coverage for City employees and administration services for the City's self-funded STD program. The competitive procurement process is designed to secure competitive, compliant, and high-quality solutions that meet the City's employee benefits requirements. The document outlines the formal contract structure and submission requirements that prospective vendors must follow when responding to this opportunity.
The forms document establishes the contractual framework and standard terms under which proposals will be evaluated and agreements executed. Vendors submitting proposals must complete and submit all required contract forms as part of their bid package. The document serves as the binding agreement template that will govern the relationship between the City of Westerville and the selected vendor for the provision of Basic Life and AD&D Insurance coverage and STD administration services.
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Text version
NONCOLLUSION AFFIDAVIT
State of:
County of:
BID Identification: Basic Life and AD&D Insurance and Short-Term Disability Administration
CONTRACTOR:
Being first duly sworn, deposes as says that he/she is:
of (sole owner, a partnership, president etc.) (name of company) the party making the foregoing BID; that such BID is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization, or corporation; that such BID is genuine and not collusive or sham; that said BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham BID, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or anyone else to put in a sham BID, or that anyone shall refrain from bidding; that said BIDDER has not in any manner, directly or indirectly, sought by agreement, communication or conference with anyone to fix the BID price of said BIDDER or of any other BIDDER, or to fix any overhead, profit, or cost element of such BID price, or of that of any other BIDDER, or to secure any advantage against the OWNER awarding the Contract or anyone interested in the proposed Contract; that all statements contained in such BID are true; and, further, that said BIDDER has not, directly or indirectly, submitted his BID price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith, to any corporation, partnership, company, association, organization, BID depository, or to any member or agent thereof, or to any other individual except to such person or persons as have a partnership or other financial interest with said BIDDER in its general business.
Signed:
Subscribed and sworn to before me this
Day of , 20
Seal of Notary
PERSONAL PROPERTY TAX AFFIDAVIT
Re:
To:
FOR
THE CITY OF WESTERVILLE, OHIO
(SECTION 5719.042 ORC)
Basic Life and AD&D Insurance and Short-Term Disability Administration
Director of Finance, City of Westerville, Ohio
State of:
County of:
By (Bidder):
Address:
Affiant:
Title:
being first duly sworn, says that on , it (check at left of paragraph 1 or 2; if 2, fill in the appropriate data):
1. Was not charged with any delinquent personal property taxes on the general tax list of personal property of Franklin and Delaware Counties
2. Was charged with delinquent personal property taxes on the general tax list of personal property of Franklin and/or Delaware Counties and the amount due and unpaid delinquent taxes, penalties, and interest are:
Tax Penalties Interest
FRANKLIN COUNTY $ $ $
DELAWARE COUNTY $ $ $
That this Affidavit shall be incorporated into the Contract between the undersigned and the City of Westerville.
Signed:
Subscribed and sworn to before me this
Day of , 20
Seal of Notary
| Personal Property Tax Affidavit.pdf |
| Re: Workers’ Compensation Self-Insurance Services (RFP-17-001(DAS-HR)) |
File details come from the government source that posted it. Updated .