General Affidavit Form printable pdf download

AFFIDAVIT

State of Ohio

County of __________

I, ______________________________,_______________________ swear that on _______________, 20___, I/we

(name of signing party)

(title)

submitted a competitive bid for a contract with Lorain County, Ohio for _________________________________.

(Project Name)

NON-COLLUSION

_________________________________________ its agents, officers, or employees have not directly or indirectly

(Insert name of individual, partnership, corporation)

entered into any agreement, participated in a collusion, or otherwise taken any action in restraint of free

competitive bidding in connection with this proposal.

ANTI-DISCRIMINATION STATEMENT

_________________________________________ does hereby agree that in the hiring of employees for the

(Insert name of individual, partnership, corporation)

performance of work under this contract or any subcontract hereunder, no contractor or sub-contractor or any

person acting on behalf of such contractor shall by reason of race, creed or color, or handicap, discriminate against

any citizen of the State of Ohio in the employment of laborers or workers who qualify and who are available to

perform the work to which this contract relates.

_________________________________________ further agrees that no contractor, subcontractor nor any person

(Insert name of individual, partnership, corporation)

acting in his behalf shall in any manner discriminate against or intimidate any employee hired for the performance

of work under this contract on account of race, creed or color, or handicap.

PERSONAL PROPERTY TAX DISCLOSURE

_____________________________________________ hereby state:

(Insert name of individual, partnership, corporation)

1. That on ______________, 20__, I/we received an award from Lorain County for the contract.

2. That at the time the competitive bid was submitted I/we had/had not been charged with

delinquent personal property taxes on general tax list of personal property of Lorain County, Ohio.

3. That the amount of due and unpaid delinquent taxes is $_________________________.

4. And that the amount of due and unpaid penalties and interest is $__________________.

REAL ESTATE TAX DISCLOSURE

_____________________________________________ hereby state:

(Insert name of individual, partnership, corporation)

1. That on ______________, 20__, I/we received an award from Lorain County for the contract.

2. That at the time the competitive bid was submitted I/we had/had not been charged with delinquent Real

Estate taxes on any parcel of real estate within Lorain County, Ohio.

3. That the amount of due and unpaid delinquent taxes is $_________________________.

4. And that the amount of due and unpaid penalties and interest is $__________________.

______________________________

___________________________________

(Signature – Title)

(Company Name)

Sworn to and subscribed before me this _____ day of _______________, 20__.

______________________________

Notary Public

THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR BID

General Affidavit Form

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