Preference Certification Statements.pdfPreference Certification Statements.pdf

CERT IFICAT ION ST AT EMENTS

***SUPPLIERS MUST COMPLETE THE APPROPRIATE CERTIFICATION BELOW TO RECEIVE THE PREFERENCE.***

Any supplier who intentionally submits false or misleading information in an attempt to receive a scoring preference will be immediately disqualified and may be subject to administrative or legal action including debarment. The State reserves the right to clarify any information during the evaluation process.

Does the cost of product(s) offered exceed 50% of the total offered cost for both products and services?

Yes (Go to A-1) No (Go to B-2)

A. DOMESTIC PREFERENCE (BUY AMERICAN): Revised Code 125.11

[Not applicable to “Excepted Products”]

1. Where is each product being offered mined, raised, grown, produced or manufactured?

United States: (State) Canada Mexico (Go to B-1) Other: (Specify Country) (Go to A-2)

2. An end product is manufactured outside the United States but at least 50% of the cost of its components are produced, mined, raised, grown or manufactured within the United States. The cost of components may include transportation costs to the place of manufacture and, in the case of components of foreign origin, duty whether or not a duty free entry certificate is issued. Yes (Go to Section B-1) No (Go to Section A-3)

3. The Supplier hereby certifies that each end product, except the products listed below, is a domestic source end product as defined in the Buy American Act and that com ponents of unknown origin have been considered to have been mined, produced, grown or manufactured outside the United States.

(Item ) (Country of Origin)

(Item ) (Country of Origin)

B. OHIO PREFERENCE (BUY OHIO): Revised Code 125.09

1. The products being offered are raised, grown, produced, mined or manufactured in Ohio.

Yes (Go to C) No (Go to B-2)

2. Supplier has significant economic presence within the State of Ohio:

a) Supplier has paid the required taxes due to the State of Ohio Yes (Go to B-2b) No (Go to B-3)

b) Supplier is registered with the Ohio Secretary of State

Yes (Charter/Registration No.: ) (Go to B-2c) No (Go to B-3) Questions regarding registration should be directed to (614) 466 -3910 or visit the SOS website at:

http://sos.state.oh.us/

c) Supplier has ten or more employees based in Ohio. Yes (Go to C) No (Go to B-2d)

d) Supplier has seventy-five percent or more employees based in Ohio.Yes (Go to C) No (Go to B-3)

3. Border state supplier: (Except products mined in Michigan)

a) Supplier has paid the required taxes due to the border state Yes (Go to B-3b) No (Go to C)

b) Supplier is registered with the applicable border state

Yes (Registration No.: ) (Go to B-3c) No (Go to C)

c) Supplier has ten or m ore employees based in a border state. Yes (Go to B-3f) No (Go to B-3d)

d) Supplier has seventy-five percent or m ore employees based in a border state.

Yes (Go to B-3f) No (Go to B-3e)

e) Is the supplier offering products that are raised, grown, produced, mined, or manufactured in a border state?

Yes (Go to B-3f) No (Go to C)

f) Specify which state: KY MI WV PA IN

C. VETERANS PREFERENCE (BUY VETERAN): Revised Code 122.925 and Administrative Code 123:5-1-16

Is the supplier a certified Veteran Friendly Business Enterprise by the Ohio Department of Development, Minority Business Development Division?

Yes No http://procure.ohio.gov/pdf/exprod.pdf http://sos.state.oh.us/