Drug Free Workplace Compliance
DRUG FREE WORKPLACE COMPLIANCE
THE CITY OF ST. MARYS, A POLITICAL SUBDIVISION OF THE STATE OF OHIO AND A RECIPIENT OF FEDERAL FUNDS, IS REQUIRED TO COMPLY WITH THE DRUG FREE WORKPLACE ACT OF 1988. THE CITY IS CONCERNED WITH THE EFFECTS DRUG OR ALCOHOL ABUSE CAN HAVE ON EMPLOYEES, THEIR FAMILIES, AND THE EMPLOYEE=S ABILITY TO PERFORM THEIR WORK SAFELY AND EFFICIENTLY.
BEFORE THE CITY OF ST. MARYS ENTERS INTO A CONTRACT FOR THE PURCHASE OF MATERIALS, EQUIPMENT, SUPPLIES, CONTRACTS OF INSURANCE, OR OTHER SERVICES, THE CONTRACTOR MUST AGREE TO THE FOLLOWING:
1.That the contractor or subcontractor employed by the City of St. Marys recognizes alcoholism and drug addiction as illnesses which are treatable, and encourages employees who may have an alcohol or drug problem to seek professional treatment or assistance on their own initiative.
2.That the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance by any employee of a contractor or subcontractor which takes place in whole or in part in the City=s workplace is strictly prohibited and may result in criminal prosecution and discipline which may include termination of contract.
3.That is an employee of the contractor or subcontractor is convicted of any Federal or State criminal drug statute for a workplace related drug offense, the contractor or subcontractor shall notify the City=s Director of Public Service and Safety of such within five (5) calendar days of conviction.
THE UNDERSIGNED AFFIRMS THAT THE NAMED CONTRACTOR COMPLIES WITH ALL OF THE REQUIREMENTS SET OUT ABOVE, AND THAT SUCH CONTRACTOR WILL CONTINUE TO COMPLY WITH THESE REQUIREMENTS FOR THE TERM OF THE CURRENT CONTRACT WITH THE CITY OF ST. MARYS AND FOR THE DURATION OF ALL FUTURE CONTRACTS WITH THE CITY.
Company:
Address:
Signature:
Print Name:
Date:
STATEMENT AS TO DELINQUENT TAXES
OHIO REVISED CODE 5719.042
(Contractor to submit statement as to delinquent taxes, incorporation.)
After the award by a taxing district of any contract let by competitive bid and prior to the time the contract is entered into, the person making a bid shall submit to the district=s fiscal officer a statement affirmed under oath that the person with whom the contract is to be made was not charged at the time the bid was submitted with any delinquent personal property taxes on the general tax list of personal property of any county in which the taxing district has territory or that such person was charged with delinquent personal property taxes on any such tax list, in which case the statement shall also set forth the amount of such due and unpaid delinquent taxes and any due and unpaid penalties and interest thereon. If the statement indicates that the taxpayer was charged with any such taxes, a copy of the statement shall be transmitted by the fiscal officer to the county treasurer within thirty days of the date it is submitted.
A copy of the statement shall also be incorporated into the contract, and no payment shall be made with respect to any contract to which this section applies unless such statement has been so incorporated as a part thereof.
This statement must be completed in its entirety and shall become a part of the contract hereto.
I HEREBY CERTIFY that
:
(name of bidder)
does not owe any delinquent personal property taxes in the Auglaize County Taxing District.
does owe delinquent taxes in the Auglaize County Taxing District,
in the amount of :$ ; with penalties and interest
in the amount of :$ .
Company: Address:
Signature: Print Name:
Phone:
STATE OF :
ss:
COUNTY OF :
On this day personally appeared before me to be known to be the individual described in and who executed the within and foregoing instrument, and acknowledged that he/she signed the same as his/her free and voluntary act and deed for the uses and purposes therein mentioned.
Given under my hand the official seal this day of , .
Notary Public
NON-COLLUSION AFFIDAVIT
(Materials Contract)
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
OATH AND AFFIRMATION
I affirm under the penalties of perjury that the foregoing facts and information are true and correct to the best of my knowledge and belief.
Dated at this day of , .
Name of Organization
BY: Title of Person Signing
ACKNOWLEDGMENT
STATE OF
ss:
COUNTY OF
being duly sworn, deposes and says that he is
of the above and that
(title) (name of organization)
the statements contained in the foregoing bid, certification and affidavit are true and correct.
Subscribed and sworn to before me this day of , .
Notary Public
Commission Expires:
County of Residence:
EEOC VENDOR COMPLIANCE STATEMENT
THE CITY OF ST. MARYS, AS A POLITICAL SUBDIVISION OF THE STATE AND AS A RECIPIENT OF FEDERAL FUNDS, IS REQUIRED BY EXECUTIVE ORDER 11246 AND OHIO REVISED CODE SECTION 125.111, TO INCLUDE IN ALL CONTRACTS FOR THE PURCHASE OF MATERIALS, EQUIPMENT, SUPPLIES, CONTRACTS OF INSURANCE, OR SERVICES, A CLAUSE IN WHICH THE CONTRACTOR AGREES TO THE FOLLOWING:
1.That, in the hiring of employees for the performance of work under the contract or any subcontract, no contractor or subcontractor, by reason of race, color, religion, sex, age, disability or military status as defined in section 4112.01 of the Revised Code, national origin, or ancestry, shall discriminate against any citizen of this state in the employment of a person qualified and available to perform the work to which the contract relates;
2.That no contractor, subcontractor, or person acting on behalf of any contractor or subcontractor, in any manner, shall discriminate against, intimidate, or retaliate against any employee hired for the performance of work under the contract on account of race, color, religion, sex, age, disability or military status as defined in section 4112.01 of the Revised Code, national origin, or ancestry.
THE UNDERSIGNED AFFIRMS THAT THE CONTRACTOR NAMED COMPLIES WITH ALL OF THE REQUIREMENTS SET OUT ABOVE, AND THAT SUCH CONTRACTOR WILL CONTINUE TO COMPLY WITH THESE REQUIREMENTS FOR THE TERM OF THE CURRENT CONTRACT WITH THE CITY OF ST. MARYS AND FOR THE DURATION OF ALL FUTURE CONTRACTS WITH THE CITY.
Company:
Address:
Signature:
Print Name:
Date:
By accepting this contract, the contractor agrees not to discriminate against any person seeking or hired for employment (ref: R.C. 125.111)
FORM OF NON-COLLUSION AFFIDAVIT
(Performance Contract)
STATE OF:
ss:
COUNTY OF:
being first duly sworn, deposes and says that he is (Sole Owner, a Partner, President, Secretary, etc.) of the party making the foregoing proposal of bid; that such bid is genuine and not collusive or sham; that said bidder has not colluded, conspired, connived, or agreed, directly or indirectly with any bidder or person, to put in a sham bid, or that such other person shall refrain from bidding, and has not in any manner, directly or indirectly sought by agreement or collusion or communication or conference, with any person, to fix the bid price of affiant or any other bidder, or to fix any overhead, profit, or cost element of said bid price, or of that of any other bidder, or to secure any advantage against the owner, or any person interested in the proposed contract; and that all statements contained in said proposal or bid are true; and further, that such bidder has not, directly or indirectly submitted this bid, or the contents thereof, or divulged information or data relative thereto to any association or to any member or agent thereof.
Affiant
Subscribed and sworn to before me this day of , 20 .
Notary Public
Commission Expires:
County of Residence: