M140-00-45-39-EDGE-Affidavit.pdf
PDF 27 KB Posted
- Attached to
- FAC MGMT 25-25046 Shipley Carpet Replacement State and local contract opportunity
- Solicitation number
- SRC0000029965
- Issued by
- Franklin County, Ohio
About this file
The document is an EDGE (Economic Diversity, Growth, and Equity) Affidavit from the State of Ohio's Standard Requirements for Public Facility Construction, specifically a Certified Statement of Intent to Contract and Perform. This form is designed for bidders or proposers to document their intent to work with an EDGE-certified business on a public construction project, with options for multi-prime, general, CM at risk, or design-build contracts.
The affidavit requires detailed information about both the primary bidder and the EDGE-certified business, including their roles (such as subcontractor, material supplier, professional services, or goods & services), business names, addresses, certification numbers, and contact information. The form allows for a detailed description of the materials, labor, services, or supplies to be provided, with the primary purpose of documenting the intended business relationship and the estimated contract value. By signing, both parties certify their intent to contract with each other, with the understanding that the statement becomes null and void if the bidder is not awarded the contract.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Addendum #1.pdf | ||
| 25-25046 Shipley Carpet Replacement- Bid Solicitation.pdf | ||
| PW Determination Cover Letter, PW Rates.pdf | ||
| 25-25046 Shipley Carpet Replacement Drawings.pdf | ||
| M140-00-43-13-Bid-Security-Form.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Document 00 45 39 - EDGE Affidavit State of Ohio Standard Requirements for Public Facility Construction
M140-00 45 39 2014 Edition (2016-MAR) Page 1 of 1
EDGE PARTICIPATION
Certified Statement of Intent to Contract and Perform
Bidder or Proposer: Submit one fully completed form for each EDGE-certified Business
Project: _________________________________________________
Project Name: _________________________________________________
A. Bidder or Proposer’s Company Name:
Mark all that apply:
_ _ Multi-Prime Contract __ General Contract __ CM at Risk Contract __ Design-Build Contract
B. EDGE-certified Business information (for contract at ANY tier)
Mark all that apply:
__ Subcontractor __ Material Supplier __ Professional Services __ Goods & Services
EDGE Business Name:
EDGE Business Address:
EDGE Certification Number: E-mail:
Contact Person: Phone:
Insert detailed description of materials, labor, services, supplies, etc. (may use industry codes – continue on separate page):
C. Certification of Intent
By signing below, the Bidder or Proposer certifies that it intends to contract with the EDGE-certified Business for the portion of the contract described above related to its Contract for this Project and for the estimated cost shown below. By signing below, the EDGE-certified Business certifies that it intends to contract with the Bidder or Proposer and intends to provide the portion of the contract described above related to the Contract for this Project for the estimated cost of:
and /100 dollars ( $ ).
In the event the named Bidder or Proposer is NOT awarded a Contract, this Statement shall be null and void.
EDGE-certified Business
Authorized Signature
Name and Title
Date Signed
Bidder or Proposer
Authorized Signature
Name and Title
Date Signed
END OF DOCUMENT
| Project Name: |
| EDGE Business Name: |
| EDGE Business Address 1: |
| EDGE Business Address 2: |
| EDGE Certification Number: |
| Email: |
| Contact Person: |
| Phone: |
| Name and Title: |
| Date Signed: |
| Name and Title_2: |
| Date Signed_2: |
| cents: |
| dollars in words: |
| amount in numerals: |
| Insert detailed description of materials labor services supplies etc 1: |
| Insert detailed description of materials labor services supplies etc 2: |
| Insert detailed description of materials labor services supplies etc 3: |
| Project Number: |
| Check Box 8: Off |
| Check Box 7: Off |
| Check Box 6: Off |
| Check Box 5: Off |
| Check Box 1: Off |
| Check Box 2: Off |
| Check Box 3: Off |
| Check Box 4: Off |
| Bidder or Proposer Company Name: |
File details come from the government source that posted it. Updated .