1-Contract Forms.pdf
PDF 186 KB Posted
- Solicitation number
- RFP-26-001(WHR)
- Issued by
- Delaware County, Ohio
About this file
This file contains contract forms for a supplemental benefits administration and insurance services solicitation issued by the City of Westerville, Ohio. The City seeks proposals from insurance carriers and third-party administrators to provide comprehensive supplemental benefits administration services for approximately 470 eligible City employees. The requested services include life insurance, accidental death and dismemberment (AD&D) coverage, short-term disability (STD) administration, medical review services, and consultation on optional voluntary benefit programs. The solicitation represents a competitive procurement process designed to secure competitive rates, comprehensive coverage, superior customer service, and efficient claims administration.
The document includes a Noncollusion Affidavit requiring bidders to certify that their bid is genuine, not collusive or sham, and that they have not engaged in any price-fixing, bid-rigging, or collusive activities with other bidders or interested parties. The file also contains a Personal Property Tax Affidavit addressing Section 5719.042 of the Ohio Revised Code, requiring bidders to disclose any delinquent personal property taxes owed to Franklin and Delaware Counties, including specific amounts for taxes, penalties, and interest. These affidavits are required to be completed and submitted as part of the bidding process and will be incorporated into the resulting contract.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-Supplemental Benefits Administration and Insurance Services RFP.pdf |
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Text version
NONCOLLUSION AFFIDAVIT
State of:
County of:
BID Identification: Supplemental Benefits Administration and Insurance Services
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)
Supplemental Benefits Administration and Insurance Services
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 .