RFQ Canon Copiers 10.24.25 Final.pdf

REQUEST FOR Quote (RFQ)

RFQ Number: SRC 34281

RFQ Title: OOD Canon Copiers

The Opportunities for Ohioans with Disabilities Agency (OOD) is requesting quotes for OOD Canon Copiers.

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

ATTACHMENTS

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

• Attachment Two – Certification Statements

• Attachment Three – Declaration Statements

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: Kelle Bevins, 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: February 23, 2026

• Targeted Contract End Date: June 30, 2026

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 must 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.

DAS/Equal Opportunity Division (EOD) 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, a DAS/EOD 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. 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 seeking an authorized dealer of Canon equipment to supply and install fourteen (14) Canon iR ADV DX C5840i and two (2) Canon iR ADV DX 529iF to the eleven (11) locations listed in Table One (1). This shall include delivery, installation and network set-up, meter reading and start-up supplies that must be included in the total cost.

B. In addition to supplying new Canon copiers, Contractor must disconnect and transport existing multifunction devices to OOD’s warehouse at 814 Freeway Drive N, Columbus, OH 43229.

2. Statement of Services:

A. Canon Copiers

i. Contractor shall provide fourteen (14) Canon iR ADV DX C5840i copiers to the locations outlined in Table One (1). Each of the fourteen (14) copiers shall have the below add-on components:

1. Voice Operation Kit D1 (0172C002AA)

2. ADF Access Handle - A1 (1095B001AA)

3. Numeric Keypad - A2 (4036C002AA)

4. Inner Finisher - L1 (4000C002BA)

5. Cassette Feeding Unit - AQ1(4030C002BA)

6. Super G3 Fax Board - AX1 (3998C001AA)

7. Braille equipped interfaces – Braille Label Kit - F1 (4085V100)

ii. Contractor shall provide two (2) Canon iR ADV DX 529iF copiers to the location outlined in Table One (1). The two (2) copiers shall have the below add-on components:

1. ADF Access Handle - A1 (1095B001AA)

2. Numeric Keypad - A2 (4036C002AA)

3. Cassette Feeding Unit - AR1(4030C002BA)

4. Super G3 Fax Board - AX1 (3998C001AA)

5. Braille equipped interfaces – Braille Label Kit - F1 (4085V100)

iii. Contractor must provide the specific Canon copiers that OOD is requesting and OOD shall not accept any alternative copier(s).

B. Delivery Requirements:

i. Contractor shall deliver the appropriate Canon Copiers to the designated locations in Table One (1).

ii. Contractor must ensure the delivery trucks have a lift gate for the delivery of the new copiers.

iii. Contractor can only deliver the Canon copiers during business hours 8:00AM-4:00PM Monday

– Thursday (excluding holidays as defined in R.C. 124.19) unless a different time and/or date is agreed upon by OOD IT Representative(s) in advance.

iv. Contractor shall provide tracking information to the OOD IT Representative(s) once the copier(s) have been shipped.

v. New copiers must be delivered to the OOD locations listed in Table 1 and signed for by an authorized OOD employee.

Table One (1)

Location Address Quantity Printer Model Number Canton, OH 816 30th St NW, Canton, OH

44709 1 iR ADV DX 529iF

Sharonville, OH 11150 Woodward Ln, Sharonville, OH 45241

1 iR ADV DX C5840i

Columbus, OH 814 Freeway Dr N, Columbus, OH 43229

1 iR ADV DX C5840i

Columbus, OH 150 E Campus View Blvd Columbus, OH 43235

6 iR ADV DX C5840i

Lakewood, OH 14725 Detroit Ave, Suite 320, Lakewood, OH 44107

1 iR ADV DX C5840i

Lima, OH 2190 Allentown Rd, Lima, OH 45805

1 iR ADV DX 529iF

Portsmouth, OH

1001 4th St, Portsmouth, OH 45662

1 iR ADV DX C5840i

Springfield, OH 239 E Columbus St, Springfield, OH 45503

1 iR ADV DX C5840i

Toledo, OH 5241 Southwyck Blvd #200, Toledo, OH 43614

1 iR ADV DX C5840i

West Chester, OH

7686 Cincinnati Dayton Rd, West Chester, OH 45069

1 iR ADV DX C5840i

Youngstown, OH

242 W Federal St, Suite 403, Youngstown, OH 44503

1 iR ADV DX C5840i

C. Installation and Network Set-up Requirements:

i. Contractor shall install copiers and complete network set-up at each OOD location outlined above in Table One (1).

ii. Contractor shall provide all start-up supplies.

1. Start-up suppliers include, but are not limited to:

a. Toner

b. All parts needed to install copier(s) (e.g. cable ties, tape)

iii. Contractor shall provide the OOD IT Representative with the IP address of the copier the day of the installation.

iv. Contractor shall provide implementation and training which includes, but is not limited to:

1. Physically connect the copier to the OOD Network, no wireless connections.

2. Load necessary print drivers.

3. Configure automatic meter readings.

4. Set up dedicated customer portal.

5. Configure all required device settings.

6. Selected key-user training, on site supervisor and/or Administrative Professional 4.

a. A basic overview of printer functionality (print, scan to e-mail, accessibility functions).

b. Training must be completed the day of the copiers being installed.

v. Contractor shall furnish all necessary supplies and crews for the completion of the work outlined in Exhibit [A].

vi. Contractor must have all sixteen (16) copiers installed at their designated locations and be fully functional by April 30, 2026.

D. Copiers at current locations:

i. Contractor shall be responsible for delivering the old copiers from each location in Table One

(1) to the OOD Warehouse located at 814 Freeway Drive N, Columbus, OH, 43229 by April 30, 2026.

1. Contractor can only deliver the old copiers during business hours 8:00AM-4:00PM Monday – Thursday (excluding holidays as defined in R.C. 124.19) unless a different time and/or date is agreed upon by OOD IT Representative(s) in advance.

E. General Requirements:

i. All work must comply with any Americans with Disabilities Act (ADA) and Occupational Safety and Health Administration (OSHA) Standards and all federal, state, and local regulations.

ii. All service work must meet and/or exceed industry standards.

iii. Contractor shall at all times, in the performance of this work, exercise due care and caution for the safety and welfare of the workers employed on the job, OOD employees, and property.

iv. Contractor shall be responsible for repairing any and all damage, caused by Contractor negligence, to the OOD owned and/or leased property and grounds at the Contractor’s expense.

v. All Contractor scheduled services must be done at times approved by the appropriate OOD IT representative. All service activities should be performed during mutually agreed upon hours unless the particular service request requires otherwise.

vi. Contractor shall provide seventy-two (72) hours, not including the weekend, notice of intended dates and time of service before scheduled services.

vii. Contractor and its personnel shall follow all OOD security check-in procedures upon arrival and while at the facility.

viii. Contractor provided services must be performed by properly trained personnel, where applicable.

3. Monitoring, Evaluation and Reporting:

A. OOD will communicate with the Contractor’s single point of contact to resolve any issues that arise.

B. Responsibilities of Contractor’s single point of contact shall include, but not be limited to:

i. All communications between Contractor and OOD IT representative.

ii. Manage and communicate with OOD IT representative system integration and training.

iii. Scheduling of installation of all Canon copiers to the proper locations.

iv. Communicate to OOD IT representative of shipping dates.

v. Coordinate delivery time and set up of Canon copiers with OOD IT representative.

vi. Coordinate drop off of old copiers with OOD IT representative.

1. Old copiers shall be in the same working condition when dropped off at the warehouse as they were when removed from the locations in Table One (1).

4. Additional Terms and Conditions:

A. Contractor shall submit a proper invoice(s) to OOD IT representative within ten (10) days after completion of the approved work.

B. Contractor shall ensure that the copiers carry a minimum 1-year warranty.

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

2. Cost: The Contractor must complete the item grid, as specified in OhioBuys.

B. Evaluation: The contract will be awarded to the lowest responsive and responsible bidder as determined by

OOD.

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: