SRC0000041742 Attachment A Offeror Certification Form.docxSRC0000041742 Attachment A Offeror Certification Form.docx
DOCX document 20 KB Posted
- Attached to
- ODJFS Junior Consultant RFP
- Solicitation number
- SRC0000041742
- Issued by
- Ohio
About this file
This is an Offeror Certification Form for the State of Ohio Department of Administrative Services (DAS) related to the ODJFS Junior Consultant RFP. The form requires offerors to certify the truthfulness and accuracy of their responses regarding their business history, legal compliance, and potential conflicts of interest over the preceding seven years. Offerors must answer yes or no to 18 questions covering critical eligibility criteria, including contract termination history, penalties exceeding $10,000, governmental actions limiting business rights, stock trading suspensions, bankruptcy proceedings, felony convictions, debarment status, and compliance with federal and Ohio state laws. Additionally, offerors must confirm valid employment authorization documentation for all personnel, compliance with political contribution limits under Ohio Revised Code Chapter 3517, and registration status with the Ohio Secretary of State. The form requires disclosure of any affirmative answers to items 1 through 11 with complete details, as such responses may result in proposal rejection at the sole discretion of the State based on the seriousness of the matter and its potential impact on contract performance.
Offerors must also disclose any actual or apparent conflicts of interest, including employment by the State of Ohio or related entities, with the understanding that such conflicts may result in proposal rejection or contract termination. By electronically signing the certification form, offerors represent that they have the authority to execute the document and certify that all provided answers are true and accurate pursuant to Ohio Revised Code Section 1306.01(H). The State reserves the right to cancel or terminate any contract if it subsequently discovers that the Contractor has an actual or apparent conflict of interest.
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OFFEROR CERTIFICATION FORM
The Offeror certifies that its responses to the following statements are true and accurate. The Offeror’s answers apply to the last seven years. Please indicate yes or no in each column.
| Yes/No |
| Description |
1.
Offeror has had a contract terminated for default or cause.
2.
Offeror has been assessed any penalties in excess of $10,000.00, including liquidated damages, under any of its existing or past contracts with any organization (including any governmental entity).
3.
Offeror was the subject of any governmental action limiting the right of the Offeror to do business with that entity or any other governmental entity.
4.
Offeror has had the trading of its stock suspended.
5.
Offeror, any officer of the Offeror, or any owner of a 20% interest or greater in the Offeror has filed for bankruptcy, reorganization, a debt arrangement, moratorium, or any proceeding under any bankruptcy or insolvency law, or any dissolution or liquidation proceeding.
6.
Offeror, any officer of the Offeror, or any owner with a 20% interest or greater in the Offeror has been convicted of a felony or is currently under indictment on any felony charge.
7.
Offeror is, or will become, subject to an unresolved finding for recovery under R.C. Section 9.24, prior to the award of a Contract arising out of this RFP, without notifying DAS of such finding.
8.
Offeror has made political contributions that exceed the limits of R.C. Chapter 3517. Refer to the Political Contributions paragraph in Part 4 – Standard Terms and Conditions.
9.
Offeror and/or an individual employed by the Offeror and/or any subcontractors has been debarred from contracting with any governmental entity.
10.
Offeror is currently or may be subject to litigation, administrative or regulatory proceedings, investigations, or similar matters.
11.
Offeror or any of the Offeror’s owners, officers, trustees, board members, subcontractors, agents, or partners have been convicted of a crime involving moral turpitude or found guilty of fraud or misrepresentation in any manner.
12.
Offeror will comply with all Federal and Ohio (Ohio Revised Code) Laws and Rules of the Ohio Administrative Code as those law and rules are currently enacted and promulgated, and as they may subsequently be amended and adopted.
13.
The Offeror will remain in compliance with R.C. Chapter 3517 for the duration of the Contract and with all applicable provisions that extend beyond the expiration of the Contract.
14.
Offeror and its subcontractors’ personnel provided for the Work will have a valid I-9 form on file with the Offeror or subcontractor, as appropriate, and will have presented valid employment authorization documents, if they are not United States citizens.
15.
Offeror has obtained a written acknowledgement from its independent contractors that they are separate and independent enterprises from the State of Ohio, the Department of Administrative Services, and the Agency for all purposes including the application of the Fair Labor Standards Act, Social Security Act, Federal Unemployment Tax Act, Federal Insurance Contributions Act, the provisions of the Internal Revenue Code, Ohio tax law, worker’s compensation law and unemployment insurance law.
16.
Offeror is an Ohio company properly registered with the Ohio Secretary of State.
17.
Offeror is a foreign corporation, not incorporated under the laws of the State of Ohio, but is registered with the Ohio Secretary of State pursuant to R.C. 1703.02 to 1703.31, as applicable.
18.
Offeror is a business entity and will not submit the Independent Contractor Acknowledgement Form.
If any answer to items 1- 11 above is affirmative, the Offeror must provide complete details about the matter. While an affirmative answer to any of these items may not automatically disqualify an Offeror from consideration, at the sole discretion of the State, such an answer and a review of the background details may result in a rejection of the Proposal. The State will make this decision based on its determination of the seriousness of the matter, the matter’s possible impact on the Offeror’s performance under the Contract, and the best interest of the State.
The Offeror certifies that neither it nor any of its personnel that may work on or benefit from the Contract has a possible conflict of interest (e.g., employed by the State of Ohio, etc.) other than the conflicts identified immediately below.
Potential Conflicts (by person or entity affected)
(Attach an additional sheet if more space is needed)
The State may reject a Proposal in which an actual or apparent conflict is disclosed. The State may cancel or terminate the Contract for cause if it discovers the Contractor has any actual or apparent conflict of interest.
☐ By checking this box, the Offeror represents that it has the authority to sign this document and understands that by checking the box, the Offeror certifies that the answers provided in this document are true and accurate and that checking the box is the same as submitting an electronic signature pursuant to R.C. 1306.01(H).
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