Norwalk Janitorial RFQ Packet.pdf

REQUEST FOR Quote (RFQ)

RFQ Number: SRC 0000036792

RFQ Title: OOD Norwalk Office Janitorial Services

The Opportunities for Ohioans with Disabilities Agency (OOD) is requesting quotes for OOD Norwalk Office Janitorial Services.

All attachments and forms required in the posted opportunity MUST be submitted with quote. Quotes must be submitted electronically at https://OhioBuys.Ohio.gov/. Only electronic bids received by the RFQ response deadline will be accepted.

Mailed, emailed, or faxed responses will NOT be accepted.

https://ohiobuys.ohio.gov/

TABLE OF CONTENTS

SECTIONS

I. General Instructions and Information

II. Timeline Requirements

III. Background and Compliance Documentation

IV. Submission Requirements and Evaluation

V. Funding Background Information

EXHIBITS

• Exhibit A – Scope of Services and Additional Terms

• Exhibit B - OOD Agreement and Signature Page

ATTACHMENTS

• Attachment One – Standard Affirmation and Disclosure – Executive Order 2022-02D

• Attachment Two – Certification Statements

• Attachment Three – Declaration Statements

• Attachment Four – Explanation of OPERS Non-Member (Independent Contractor) Acknowledgment

(PEDACKN)

o Attachment Four-A – Non-Member Acknowledgment (PEDACKN) o Attachment Four-B – Statement of Non-Applicability of Non-Member Acknowledgment Form

All documents referenced above are included in this document or in the Solicitation Documents section in OhioBuys.

The Contractor is required to complete the Attachments within this RFQ and submit them in the corresponding question in the OhioBuys questionnaire, along with any other requested documentation.

SECTION I. – GENERAL INSTRUCTIONS AND INFORMATION

General Notes

• Submission of questions or clarifications of the RFQ must be submitted as directed in Section I. – “General Instructions and Information”.

• The State is not responsible for the accuracy of any information regarding this RFQ that was gathered through a source different from the inquiry/clarification process described in Section I.

• There will be no exceptions to the RFQ Submission Deadline Date/Time regardless of the cause for delay.

• By submitting a response, the Contractor acknowledges that they have read this RFQ, understand it, and agree to be bound by its requirements.

• OOD reserves the right to contract with multiple Contractors.

Inquiries/Clarifications

• Contractors may make inquiries or seek clarifications regarding this RFQ any time during the inquiry period. To make an inquiry or seek clarification, Contractors must utilize OhioBuys which can be found at ohiobuys.ohio.gov.

• Contractors may view inquiries and responses on the OhioBuys Public Solicitations page by opening the

Solicitation Overview and navigating to the inquiries section of that page.

• Contractors are to base their RFQ responses, and the details and costs of their proposed projects, on the requirements and performance expectations established in this RFQ for the future contract, not on details of any other potentially related contract or project.

• If Contractors ask questions about existing or past contracts using the inquiry process, OOD will use its discretion in deciding whether to provide answers as part of this RFQ process.

• Contractors who attempt to inquire or seek clarification verbally, electronically or by mail, will be directed in accordance with the method detailed above. No other form of communication is acceptable.

Use of any other form of communication or any attempt to communicate with OOD staff or any other agency of the State to discuss this RFQ may result in the Contractor being deemed not responsive.

• OOD will try to respond to all inquiries within 48 hours of receipt, excluding weekends and holidays as defined in R.C. 124.19.

• Contractors will not receive a personalized e-mail response to their question, nor will they receive notification when the question has been answered.

• OhioBuys provides the primary platform for Supplier Partners to engage in procurement activities with the State of Ohio. For additional information on accessing OhioBuys or OhioBuys Training, please visit https://procure.ohio.gov/bidders-and-suppliers https://ohiobuys.ohio.gov/page.aspx/en/usr/login?ReturnUrl=%2Fpage.aspx%2Fen%2Fbuy%2Fhomepage https://procure.ohio.gov/bidders-and-suppliers

• If you encounter an issue or have a question regarding OhioBuys, please contact the OBM Shared Services Help Desk via email at OBM.SharedServices@OBM.Ohio.Gov - Please use "OhioBuys" in the subject line or contact via phone at 614-338-4781 or 1-877-OHIOSS1 (1-877-644-6771).

RFQ Response Deadline and Requirements

• All RFQ responses must be received by the published submission deadline date and time.

• Each Contractor shall submit the completed RFQ response electronically at ohiobuys.ohio.gov. The response must include all documents requested via the OhioBuys solicitation. The acceptable delivery method for submission of RFQ responses is only via OhioBuys. Mailed, emailed, or faxed responses will NOT be accepted.

• OhioBuys will not allow any responses to be accepted after the deadline regardless of the cause for delay. The date and time stamp on the electronic submission in OhioBuys will be accepted as the official receipt time.

• OOD may refuse any RFQ response if the Contractor takes exception to the terms and conditions of this RFQ, fails to comply with the procedure for participating in the RFQ process, or the Contractor’s response fails to meet any requirement of this RFQ. OOD may also refuse any response that it believes is not in its best interest to accept and may decide not to do business with any of the potential contractors responding to this RFQ.

• To protect the integrity of the evaluation and award process, RFQ responses will not be available for public viewing until after the contract has been officially awarded. Contractors may not contact OOD staff, other contractors, or any other member of the State to discuss their RFQ response or to discuss any of the other RFQ responses. Contractors who attempt to make such contacts may be deemed not responsive.

• All RFQ responses and other submitted material will become the property of OOD and will not be returned. The Contractor should not include confidential, proprietary, or trade secret information in an RFQ response because OOD maintains the right to use any materials or ideas submitted without compensation to the Contractor. Additionally, all responses will be open to the public after OOD awards the contract(s).

• OOD will retain all RFQ responses or a copy of them, as part of the contract file for the period of the contract and any subsequent renewals. After the retention period, OOD may return, destroy, or otherwise dispose of the RFQ responses and copies.

Waiver of Defects

• OOD maintains the right to waive any defects in any RFQ response or in the Contractor’s submission process. OOD will only waive immaterial defects if it believes that it is in OOD’s interest.

RFQ Response Instructions OOD wants clear and concise responses. Contractors should take care to completely answer questions, where applicable, and meet all RFQ requirements.

OOD will not be liable for any costs incurred by any Contractor in submitting a quote, even if OOD does not award a Contract through this process. OOD may also cancel this RFQ and contract for these services through some other process or by issuing another RFQ.

mailto:OBM.SharedServices@OBM.Ohio.Gov https://ohiobuys.ohio.gov/page.aspx/en/usr/login?ReturnUrl=%2Fpage.aspx%2Fen%2Fbuy%2Fhomepage

To be considered for an award, quotes must be judged as responsive and responsible in accordance with the selection criteria listed in Exhibit A. In addition, the following will be considered:

Responsive: A Contractor is responsive if the quote substantively complies with the RFQ specifications and all prescribed documentation and attachments. Quotes should not deviate from the specifications that would affect the amount of the RFQ response or otherwise give the Contractor an unfair advantage.

Responsible: OOD’s determination of a Contractor’s responsibility will be based on factors such as:

• Experience of the Contractor

• Contractor’s financial condition

• Contractor’s conduct and performance on previous contracts

• The Contractor’s facilities (if applicable)

• The Contractor’s management skills

• The Contractor’s ability to execute the contract properly, and

• Review of Federal and State of Ohio debarment lists

Contacts The following RFQ Representative will represent OOD during the RFQ process:

Name: Tonya Senter, Senior Sourcing Analyst Address: 150 E. Campus View Blvd.

Columbus, OH 43235 Email: ood.purchasing@ood.ohio.gov

Note: If a supplier is offered an opportunity to move into a contract, OOD will provide the awardee(s) with the name of a contract liaison in writing.

mailto:ood.purchasing@ood.ohio.gov

SECTION II. – TIMELINE REQUIREMENTS

Targeted Dates

• Targeted Contract Begin Date: July 1, 2026

• Targeted Contract End Date: June 30, 2027

RFQ Response Amendments Amendments of RFQ responses are allowed until the RFQ Response Deadline Date and Time. No amendments will be permitted after this date or time.

RFQ Response Withdrawals Withdrawal of RFQ responses must be submitted electronically at https://OhioBuys.Ohio.gov/. If a Bidder or Supplier has submitted multiple responses for a solicitation, each response will need to be individually withdrawn to be removed. All RFQ response withdrawals need to occur prior to the Bid Due Date for a solicitation.

https://ohiobuys.ohio.gov/

SECTION III. – BACKGROUND AND COMPLIANCE DOCUMENTATION

The intent of this section is to clarify the background and compliance documentation that is required with the quote submission.

Declarations Statement Contractors must sign and return the “Declarations Statement” attachment with their response. An explanation is provided on the attachment for each of the following areas:

• Ohio Election Law Information

• Ohio Ethics and Conflict of Interest Laws Information

• Equal Employment Opportunity Law Information

• Contract Performance – A Contractor must respond to several statements regarding the past seven (7) years and if any affirmative answer is provided, details must be provided.

• Conflict of Interest

• Contractor Checklist

Statement of Compliance OOD intends for the Awardee, all of the Awardee’s employees and/or subcontractors to implement and comply with the following: all federal and Ohio laws (i.e. Ohio Revised Code [R.C.], Ohio Administrative Code [Ohio Adm.Code]; OOD policies, procedures and Community Rehabilitation Program Standards; State and/or Federal Fiscal Management/Audit Standards; and standards pertaining to vocational rehabilitation (VR) services as those laws, rules and policies, and standards are currently enacted and promulgated and as they may subsequently be amended and adopted. The Awardee agrees that any students, interims, or residents, as part of a formal training program, will work under staff supervision commensurate with their level of training.

Ohio Administrative Knowledge System (OAKS) Supplier Identification Number Each response should include the Contractor’s Ohio Administrative Knowledge System (OAKS) identification number. If Contractor does not currently have an OAKS identification number, visit ohiopays.ohio.gov to create a new Payee registration. Please note that obtaining an OAKS payee identification number may take up to five

(5) business days.

Ohio Department of Development/ Minority Business Development Division (MBDD) Certification Number If the RFQ is an MBE/EDGE set-aside opportunity, it will be clearly marked on the cover page. If the RFQ is an MBE/EDGE set-aside opportunity, an Ohio Department of Development/MBDD Certification # (for MBE/EDGE) will need to be provided with the response. To obtain MBE/EDGE certification, an application must be submitted to the Ohio Department of Development/MBDD. More information regarding each program, including a link to the application and steps for application, can be found at:

https://development.ohio.gov/business/minority-business/business-certifications/office-of-business-certifications https://ohiopays.ohio.gov/ https://development.ohio.gov/business/minority-business/business-certifications/office-of-business-certifications https://development.ohio.gov/business/minority-business/business-certifications/office-of-business-certifications

Veteran-Friendly Business Enterprise Program (VBE) The Veteran-Friendly Business Enterprise (VBE) program provides preference or bonus points to certified companies competing for State contracts, including eligible construction services. The legal authority for the program is R.C. 9.318, while its administrative rules are found in Ohio Adm.Code 123:5-1-01 and 123:5-1-16.

The VBE program applies to all state agencies’ purchases made by bid, quote, or proposal under R.C. 125. The VBE program allows for scores on proposals submitted by veteran-friendly businesses to be up to five percent lower than the proposal scores submitted by businesses not certified as veteran-friendly and still be eligible for winning the award. More information regarding this program, including a link to the application and steps for application, can be found at:

https://development.ohio.gov/business/minority-business/business-certifications/veteran-friendly-business-enterprise-procurement-program https://development.ohio.gov/business/minority-business/business-certifications/veteran-friendly-business-enterprise-procurement-program https://development.ohio.gov/business/minority-business/business-certifications/veteran-friendly-business-enterprise-procurement-program

OPPORTUNITIES FOR OHIOANS WITH DISABILITIES AGENCY

EXHIBIT [A]

SCOPE OF SERVICES AND ADDITIONAL TERMS

1. Statement of Need:

A. Opportunities for Ohioans with Disabilities (OOD) is requesting quotes for janitorial services to begin July

1, 2026, through June 30, 2027, at our Norwalk Office located at 105 Cleveland Rd, Ste. A, Norwalk, OH 44857.

2. Statement of Services:

A. Work schedule:

1. Contractor agrees to provide janitorial services to the OOD office at a minimum of three (3) days a week and shall be responsible for providing all necessary supplies, labor, and supervision of the services.

2. The janitorial services shall be completed outside of the regular office hours, prior to the office opening at 8:00 AM or after the office closes at 5:00 PM. The Contractor shall provide the OOD designated representative with the weekly schedule of services that is agreed upon by Contractor and OOD.

OOD offices operate on a Monday through Friday schedule, excluding holidays as defined in R.C.124.19.

When a holiday falls on a non-workday, the holiday shall be observed on Monday (if the holiday falls on a Sunday) or Friday (if the holiday falls on a Saturday). Offices are closed during the observed holiday.

3. OOD reserves the right to suspend service temporarily due to inclement weather. A minimum of four (4) hours’ notice must be given to the Contractor in order for a proportional amount to be reduced or suspended in the payment.

4. Contractor agrees to furnish necessary personnel, supplies and equipment (unless otherwise noted herein) to provide janitorial service.

5. Contractor shall provide a single point of contact to the OOD designated representative.

6. Contractor's employees shall sign in and out utilizing a sign in/out sheet supplied by OOD and retained by the OOD designated representative.

7. Employees of the Contractor shall wear at least a shirt with the Contractor's name and/or other identifying wording to provide identification of themselves to anyone entering facilities or properties where they are providing services.

B. Description of the premises:

1. The OOD Norwalk location contains the following spaces as laid out in Figure One – OOD Norwalk Office Floor Plan.

a. Proximately 3,500 square feet of space

b. Two (2) restrooms

c. One (1) kitchen/breakroom

d. Lobby area

e. Reception/Admin area

f. Two (2) open workrooms

g. Five (5) offices

h. One (1) interview office

i. One (1) conference room

j. One (1) vestibule/entrance area

k. Hallways

C. Janitorial Services shall be performed three (3) times per week:

1. Restrooms:

a. Clean sinks, toilets, restroom door handles, and floor

b. Wash walls and baseboards, as needed

c. Replenish paper towels, hand soap, toilet paper and toilet seat covers, as needed

d. Empty trash cans and replace bags

e. Clean mirrors

2. Kitchen/Breakroom:

a. Vacuum and/or mop floors

b. Wipe down/dust furniture, countertops and baseboards

c. Empty all trash cans and replace bags

d. Clean inside and outside of glass doors and windows

e. Clean kitchen sink/faucet

f. Wipe down/clean outside of refrigerator

g. Wipe down/clean outside and inside of microwave

3. Lobby and Receptionist areas, Offices, Conference rooms, Hallways and Work Areas:

b. Wipe down/dust furniture and baseboards

c. Empty all trash cans and replace bags

d. Clean inside and outside of glass doors and windows

4. Vestibule/Entrance Area

b. Wipe down/dust baseboards

c. Clean inside and outside of glass doors and windows

5. The Contractor shall be responsible for the disposal of all liquid and solid waste. At no time shall the Contractor bring items to, or on, OOD property for disposal. In no circumstance shall any material be poured down the drain or disposed of improperly.

6. After all cleaning operations have been completed, all office furniture, (e.g. chairs, desks, tables, etc.), shall be placed in their proper position and the premises shall be left in an orderly condition.

7. Subject to mutual agreement, additional duties, assignments, tasks and responsibilities may be requested. No additional services shall commence until an amendment to the OOD contract has been duly executed and approved in writing by all parties.

D. Supplies and Equipment:

1. Contractor shall have access to an onsite 4'x5' utility closet, that also houses the furnace, for storage of equipment and supplies. There is a mop sink directly next to the utility closet. All equipment and supplies shall be stored in the utility closet at all times, when not in use.

2. A listing of all chemicals and copies of Material Safety Data Sheets (MSDS) used in performing work shall be submitted to and approved by the OOD designated representative. This information shall also be kept and maintained at the OOD Norwalk office location.

3. All equipment used to perform work shall be of acceptable commercial quality. A list of all equipment kept on site shall be provided to the OOD designated representative prior to the beginning of services. The list shall include make, model, purchase date, purchase price, and serial number or other method of identification.

4. Contractor shall provide the following supplies, including, but not limited to:

a. Cleaning chemicals

b. Mops and Vacuum

c. Toilet paper

d. Hand soap

e. Paper towels

f. Trash bags

g. Toilet Seat Covers

3. Additional Fiscal or Budget Requirements:

A. Contractor shall cooperate with all billing outlined in this Agreement, as well as any additional fiscal requirements and documentation, that is mutually agreed to by the parties and specifically authorized by

OOD.

B. The Contractor shall submit the invoice to OOD on a monthly basis. Payment date shall be within thirty

(30) days of receipt of a proper invoice.

4. Monitoring, Evaluation and Reporting:

A. OOD personnel may inspect the performance throughout the Agreement.

B. The Contractor shall conduct quarterly inspections, for quality control and ensure all deliverables outlined in Exhibit A are satisfactorily completed, and ensure any deficiencies are corrected.

C. The Contractor shall keep records of the quarterly inspection documents and provide copies to the OOD designated representative, upon request.

D. OOD shall communicate with Contractor’s single point of contact to resolve any issues that arise.

Communication may include a description of service issues, required remediation, and a specific timeframe to correct the issue(s).

Figure One – OOD Norwalk Office Floor Plan

SECTION IV. – SUBMISSION REQUIREMENTS AND EVALUATION

A. OhioBuys Submission:

Each Contractor must submit the identified background and compliance documentation, as well as other identified response documentation, where specified in the OhioBuys questionnaire.

1. Background and Compliance Documentation:

a. Attachment One – Standard Affirmation and Disclosure Form – Executive Order 2022-02D

b. Attachment Two – Certification Statements

c. Attachment Three – Declaration Statements

d. Attachment Four A OR Attachment Four B (Contractor must choose applicable document) – Non- Member Acknowledgement (PEDACKN) OR Statement or Non-Applicability of Non-Member Acknowledgement Form

2. Cost:

a. The Contractor must complete the item grid, as specified in OhioBuys.

b. Contractor must submit a formal quote.

B. Evaluation:

OOD reserves the right to reject, in whole or in part, any and all responses if any of the following circumstances are true:

1. Responses that offer supplies or services that are not in compliance with the requirements, specifications, terms, or conditions stated in this document and/or the RFQ.

2. The price of the lowest responsive and responsible bid is deemed excessive in comparison with market conditions or with OOD’s available funds.

OOD shall select the lowest responsive and responsible bid based on the estimated total cost.

SECTION V.-FUNDING BACKGROUND INFORMATION

Funding Background Information:

Programs provided by Opportunities for Ohioans with Disabilities (OOD) are funded, in whole or in part, with federal grants awarded by the U.S. Department of Education (DOE) or the U.S. Department of Health and Human Services (HHS). For purposes of the Vocational Rehabilitation (VR) Program, including Pre-Employment Transition Services (Pre-ETS), OOD received 78.7% of its funding through the DOE VR grant. In federal fiscal year (FFY) 2025, OOD received $177,897,297 in federal funds. Funds appropriated by the state covered 21.3 % of the total costs, or $48,147,553. Of these federal funds, $26,684,595 is set aside for Pre-ETS.

For purposes of the Works4Me Program, OOD received 100% of its funding through the DOE Disability Innovation Fund grant. In FFY 2025, OOD received $1,793,225 for this Program.

For purposes of the Supported Employment (SE) Program, the DOE SE grant funded 90% of the costs for this Program up to the grant amount and 100% of the costs of the regular Supported Employment Program up to the grant amount. In FFY 2025, OOD received $446,137 for SE Youth with a Disability, and state-appropriated funds paid the remaining 10%, or $49,571 of the total costs. In FFY 2025, OOD received $446,137 in regular SE grant funds.

For purposes of the Independent Living Services Older Blind (ILOB) Program, the federal grant received from DOE in FFY 2025 paid 90% of the total costs incurred under the Program. In FFY 2025, OOD received $1,129,124 in federal grant funds. Funds appropriated by the state paid the 10% required match, or $125,458 of the total costs incurred under the ILOB Program. For purposes of the Independent Living (IL) Program, the federal grant received from HHS paid 90% of the total costs incurred in FFY 2025. In FFY 2025, OOD received $640,682 in federal grant funds. Funds appropriated by the state paid the 10% required match, or $71,187 of the total costs incurred under the IL Program.

ATTACHMENT ONE

DEPARTMENT OF ADMINISTRATIVE SERVICES

STANDARD AFFIRMATION AND DISCLOSURE FORM

CONTRACTOR/SUBCONTRACTOR AFFIRMATION AND DISCLOSURE:

Contractor affirms that Contractor has read and understands the applicable Executive Orders regarding the prohibitions of performance of offshore services, locating State data offshore in any way, or purchasing from Russian institutions or companies.

The Contractor shall provide all the name(s) and location(s) where services under this Contract will be performed and where data is located in the spaces provided below or by attachment. Failure to provide this information may result in no award. If the Contractor will not be using subcontractors, indicate “Not Applicable” in the appropriate spaces.

1. Principal location of business of Contractor:

(Address) (City, State, Zip)

Name/Principal location of business of subcontractor(s):

(Name) (Address, City, State, Zip)

2. Location where services will be performed by Contractor:

(Address) (City, State, Zip)

Name/Location where services will be performed by subcontractor(s):

3. Location where state data will be stored, accessed, tested, maintained or backed-up, by Contractor:

(Address) (Address, City, State, Zip)

Name/Location(s) where state data will be stored, accessed, tested, maintained or backed-up by subcontractor(s):

4. Location where services to be performed will be changed or shifted by Contractor:

(Address) (Address, City, State, Zip)

Name/Location(s) where services will be changed or shifted to be performed by subcontractor(s):

Contractor also affirms, understands and agrees that contractor and its subcontractors are under a duty to disclose to the State any change or shift in location of services performed by Contractor or its subcontractors before, during and after execution of any contract with the State. Contractor agrees it shall so notify the State immediately of any such change or shift in location of its services. The State has the right to immediately terminate the contract, unless a duly signed waiver from the State has been attained by the Contractor to perform the services outside the United States.

On behalf of the Contractor, I acknowledge that I am duly authorized to execute this Affirmation and Disclosure Form and have read and understand that this form is a part of any Contract that Contractor may enter into the with the State and is incorporated therein.

Signature of Contractor Print Name and Title

Date

ATTACHMENT TWO - CERTIFICATION STATEMENTS

Contractors claiming preference for Domestic Source End Products, the Ohio (Buy Ohio) preference, and/or Veteran Friendly Business Enterprise (VBE) must complete the Preference Certification Statements form.

https://procure.ohio.gov/static/pdf/StateLocalAgencies/Resources_Forms/Preference%20Certification%20Statements%207.23.pdf

ATTACHMENT THREE - DECLARATION STATEMENTS

The following Declaration Statements are being certified by (Contractor) and whose authorized signature is located at the bottom of this document.

Failure to complete, sign and return this Declarations Statement with the RFQ Response, may deem the response non-responsive.

Ohio Elections Law Information

A. Prohibition State agencies whose directors or heads are appointed by the Governor are prohibited by Divisions (I) and (J) of Section 3517.13 of the Revised Code from awarding any noncompetitively bid contract for the purchase of goods or services costing more than $500.00 to an entity listed in those Divisions if a party listed in those Divisions or the spouse of such party has made, as an individual, within the two previous calendar years, one or more contributions totaling in excess of $1,000.00 to the Governor or to the Governor’s campaign committee.

B. Individual, Partnership, Association, Estate or Trust A vendor that is an individual, partnership, association, including, without limitation, a professional association organized under Chapter 1785. of the Revised Code, estate, or trust shall include in its bid an affirmative statement that, as applicable to the vendor, no such individual or spouse of such individual has made, and no partner, shareholder, administrator, executor, or trustee, or the spouses of any of them has made, as an individual, within the two previous calendar years, one or more contributions totaling in excess of $1,000.00 to the Governor or to the Governor’s campaign committee, consistent with the restrictions of Section 3517.13 (I) of the Revised Code.

C. Corporation or Business Trust A vendor that is a corporation or business trust, except a professional association organized under Chapter 1785. of the Revised Code, shall include in its bid an affirmative statement that no owner of more than twenty percent of the corporation or business trust or the spouse of such person, has made, as an individual, within the two previous calendar years, taking into consideration only owners for all of such period, one or more contributions totaling in excess of $1,000.00 to the Governor or to the Governor’s campaign committee, consistent with the restrictions of Section 3517.13 (J) of the Revised Code.

Ohio Ethics and Conflict of Interest Laws Information

Contractor, by signature on this document, certifies: (1) it has reviewed and understands the Ohio ethics and conflict of interest laws, and (2) will take no action inconsistent with those laws and any applicable order. The Contractor understands that failure to comply with Ohio ethics and conflict of interest laws may, in itself, be grounds for termination of this contract or grant and may result in the loss of other contracts or grants with the State of Ohio. Additional information concerning Ohio ethics laws may be found by accessing the following website: www.ethics.ohio.gov http://www.ethics.ohio.gov/

Equal Employment Opportunity Information The Contractor will comply with all state and federal laws regarding equal employment opportunity, including Ohio Revised Code Section 125.111 and all related Executive Orders.

Contract Performance:

The Contractor must provide the following information for this section for the past seven (7) years. Please indicate “Yes” or “No” in each column. If the answer to any item is affirmative, the Contractor must provide complete details about the matter on a separate page.

Yes/No Description

The Contractor has had a contract terminated for default or cause. If so, the Contractor must submit full details, including the other party's name, address, and telephone number.

The Contractor has been assessed any penalties in excess of five thousand dollars ($5,000), including liquidated damages, under any of its existing or past contracts with any organization (including any governmental entity). If so, the Contractor must provide complete details, including the name of the other organization, the reason for the penalty, and the penalty amount for each incident.

The Contractor was the subject of any governmental action limiting the right of the Contractor to do business with that entity or any other governmental entity.

Trading in the stock of the company has ever been suspended with the date(s) and explanation(s).

The Contractor, any officer of the Contractor, or any owner of a twenty percent (20%) interest or greater in the Bid has filed for bankruptcy, reorganization, a debt arrangement, moratorium, or any proceeding under any bankruptcy or insolvency law, or any dissolution or liquidation proceeding.

The Contractor, any officer of the Contractor, or any owner with a twenty percent (20%) interest or greater in the Bid has been convicted of a felony or is currently under indictment on any felony charge.

Conflict of Interest:

Additional information regarding Conflict of Interest and Ethics Compliance, as it relates to award of this RFQ, may be found in Standard Terms and Conditions, Article 15.

The Contractor must include a statement indicating whether the Contractor, or any people that may work on the project through the Contractor, have any possible conflict of interest, direct or indirect, which is incompatible with the fulfillment of these services. Provide a statement regarding any potential Conflict of Interest, if applicable:

While an affirmative answer to any of the items in the Contract Performance checklist or, inclusion of a statement of possible Conflict of Interest, will not automatically disqualify a Response from consideration, such an answer or statement and a review of the background details may result in a rejection of the Response at the sole discretion of the evaluation team. The team will make this decision based on its determination of the seriousness of the matter, the matter’s possible impact on the Contractor’s performance on the project, and the best interests of the State.

Contractor Checklist:

Indicate Yes or No for each question and provide an explanation below, when specified: Yes/No

Have you had experience with providing services as described in Scope of Work?

Have you had past performance on previous state contracts?

If yes, include agency, contract title(s) and contract number(s) in the box below.

This Response covers all Statement of Services listed on Scope of Work.

If No, please explain specific statement of services that could not be met in the box below.

Explanation of any of the above:

CONTRACTOR CERTIFICATION:

I attest that I am a representative of the organization listed in this Response and have the authority to bind the Contractor to the aforementioned requirements in this Declaration Statements.

Printed Name and Title:

Signature and Date:

Organization:

ATTACHMENT FOUR

Explanation of Public Employee Retirement (OPERS)

Non-Member (Independent Contractor) Acknowledgment

Pursuant to Ohio Revised code (R.C.) Section 145.038, Opportunities for Ohioans with

Disabilities (OOD) is required to inform independent contractors who begin providing services to it on or after January 7, 2013, that no contributions will be made on their behalf to the Ohio Public Employees Retirement System (OPERS). All such independent contractors are also required to complete an Independent Contractor Acknowledgement form (PEDACKN).

All independent contractors who are NOT employed by a "business entity" may request that

OPERS determine whether the contractor is a public employee for purposes of R.C. Chapter 145.

A business entity is defined as an entity with five (5) or more employees that is a corporation, association, firm, limited liability company, partnership, sole proprietorship, or other entity engaged in business.

Please complete the PEDACKN Form, linked in Attachment Four-A, if appropriate, and submit in the corresponding OhioBuys question as part of your response. If the form is not applicable, please complete Attachment Four-B.

OOD WILL NOT SIGN THE AGREEMENT UNTIL THE FORM OR INFORMATION BELOW IS

COMPLETED. If you have any questions regarding R.C. 145.038 or the attached PEDACKN, please contact OPERS at 1-888-400-0965.

Thank you, OOD Division of Legal Services

ATTACHMENT FOUR-A

Fill out the form linked below, if applicable, and submit in OhioBuys.

https://www.opers.org/forms-archive/PEDACKN-Non-Member-Acknowledgment.pdf https://www.opers.org/forms-archive/PEDACKN-Non-Member-Acknowledgment.pdf

ATTACHMENT FOUR-B

Statement of Non-Applicability of Non-Member Acknowledgment Form

The Independent Contractor Acknowledgment form is not applicable to________________. We have five

(5) or more employees, and are either a corporation, association, firm, limited liability company, partnership, sole proprietorship, or other entity.

Signature of Contractor: _______________________________________________

Date: ______________________________________________________________