3-Attachment A.pdf

AFFIDAVIT

STATE OF ______________________ )

) SS.

COUNTY OF ____________________ )

_________________________________of the city of ________________________________ County of ____________________ State of __________________being duly sworn on her or his oath, deposes and says;

1. That I am the _________________________ (Title of Affiant) of __________________________________(Name of Bidder) and have been authorized by said Bidder to make this Affidavit upon my best information and belief, after reasonable inquiry as to the representations herein.

2. No Officer, Agent or Employee of Jackson County, Missouri is financially interested directly or indirectly what Bidder is offering to sell to the County pursuant to this Invitation (though no representation is made regarding potential ownership of publicly traded stock of bidder).

3. If Bidder were awarded any contract, job, work or service for Jackson County, Missouri, no Officer, Agent or Employee of the

County would be interested in or receive any benefit from the profit or emolument of such.

4. Either Bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri and is not delinquent in the payment of any taxes due to the County or Bidder did not have on December 31, 2025, any property subject to taxation by the County and if bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri, bidder agrees to permit an audit of its records, if requested by the Jackson County Director of Assessment, as they relate to the assessment of Business Personal Property.

5. Bidder has not participated in collusion or committed any act in restraint of trade, directly or indirectly, which bears upon anyone's response or lack of response to the Invitation.

6. Bidder certifies and warrants that Bidder or Bidder's firm/organization is not listed on the General Services Administration's Report of Debarred and/or Suspended Parties.

7. Bidder certifies and affirms its enrollment and participation in a federal work authorization program with respect to the employees working in connection with the contracted services.

8. Bidder certifies and affirms that it does not knowingly employ any person who is an unauthorized alien in connection with the contracted services.

_______________________________ (Name of Bidder)

By: ____________________________ (Signature of Affiant)

_______________________________ (Title of Affiant)

Subscribed and sworn to before me this ______ day of _________________, 20____

NOTARY PUBLIC in and for the County of _______________________________(SEAL)

State of _____________________________

My Commission Expires: ______________________________________________

OFFICE OF THE COUNTY AUDITOR

COMPLIANCE REVIEW OFFICE

415 E 12TH STREET, 2ND FLOOR

KANSAS CITY, MISSOURI 64106

(816) 881-3302

FAX (816) 881-3340

COMPLIANCE@JACKSONGOV.ORG

WWW.JACKSONGOV.ORG/AUDITOR

CERTIFICATE OF COMPLIANCE NOTICE:

All vendors doing business with Jackson County are required to obtain a Certificate of Compliance issued by the Jackson County Compliance Review Office.

A Certificate of Compliance is required to be submitted with any bid response.

Failure to comply with this requirement may result in the REJECTION of a bid.

Vendors may complete a

Certificate of Compliance Application by visiting https://www.jacksongov.org/Government/Departments/Com pliance-Review-Office/Certificate-of-Compliance

A Certificate of Compliance will certify that vendors meet the following requirements:

1. Are duly listed and assessed on the tax rolls of Jackson County and are not delinquent in the payment of any taxes due to the County, or do not have on December 31st of the previous year any property subject to taxation by Jackson

County.

2. Attest and agree to Chapter 6 of the Jackson County Code which prohibits discriminatory practices and promotes Equal Employment Opportunity by contractors doing business with Jackson County.

Certificate of Compliance Application must be submitted five (5) business days prior to a bid response deadline to allow sufficient time to process. A Certificate of

Compliance is not guaranteed if this timeline is not met.

QUESTIONS? Email compliance@jacksongov.org mailto:COMPLIANCE@JACKSONGOV.ORG http://www.jacksongov.org/AUDITOR https://www.jacksongov.org/Government/Departments/Compliance-Review-Office/Certificate-of-Compliance https://www.jacksongov.org/Government/Departments/Compliance-Review-Office/Certificate-of-Compliance mailto:compliance@jacksongov.org

ACKNOWLEDGMENT OF RECEIPT OF ADDENDA

We acknowledge the receipt # of Addenda ______________ for this Request for Proposal. We understand that additional addenda may be issued up until the Question Response Deadline of 5:00 pm CT January 6, 2026, and acknowledge that we will be responsible for checking the Bonfire Portal regularly for any new addenda issued.

Signature of Respondent Date

Company Name

Address

City, State, and Zip Phone

BIDDER'S EXCEPTIONS

TO

SCOPE OF SERVICES

OF

JACKSON COUNTY, MISSOURI REQUEST FOR PROPOSAL NO. 25-051

Respondent's attention is directed to Paragraph 4 of the General Conditions of this Invitation to Bid. READ THIS PARAGRAPH

CAREFULLY.

The following exceptions to the Specifications of Request for Proposal No. 25-051 are requested by the undersigned Respondent: (Use additional pages as necessary.)

REFERENCE

PARA # & PAGE #

EXCEPTION REQUESTED

Name of Firm:

Signature of Bidder: