IFB JF26014 Trade-in Surplus of Police Equipment for Tactical Equipment

C I T Y O F D A Y T O N, O H I O
AD # 07/23 & 07/24 INVITATION FOR BID
IFB No. JF26014
Division of Procurement
Room 514, CITY HALL
101 W. Third St.
DAYTON, OHIO 45402
Trade-in of Surplus Police Equipment for Tactical Equipment
For Further Information Contact: Date: July 23, 2026
John Finley
Room 514, CITY HALL Nicole Fox, NIGP-CPP
101 W. Third St. Purchasing Agent
Dayton OH 45402
Phone No. 937-333-4016
ELECTRONIC PDF BIDS MUST BE RECEIVED IN THE DIVISION OF PROCUREMENT EMAIL TO bids@daytonohio.gov
NO LATER THAN: 3:00 P.M. local (Dayton OH) time on August 4, 2026
User Agency: Police
Your electronic PDF bid is requested for the following: The City of Dayton is soliciting competitive bids from qualified
vendors to furnish the new tactical equipment identified in this Invitation For Bid. As part of the bid, vendors shall also
submit trade-in values for the City's surplus police firearms, equipment, and accessories identified herein. Trade-in
values will be applied as a credit toward the purchase of the tactical equipment, and award will be based on the resulting
net cost to the City.
A copy of this bid may be found on the City's Website at: http://www.daytonohio.gov/bids.aspx
Questions: Please submit all questions in writing to John Finley at john.finleyjr@daytonohio.gov no later than 10:00 AM
on July 27, 2026. Answers will be posted by end of business on July 29, 2026.
All Vendors must submit a current copy of their W-9 with the Bid. If you have not registered with the City of Dayton,
please complete and submit your complete Vendor Application form. Forms must be on file with the City of Dayton
before any Purchase Order or contract can be awarded with your company.
Forms can be found on the City of Dayton's website at: http://www.daytonohio.gov/781/Doing-Business-With-the-
City-of -Dayton.
Submit one (1) signed original PDF of bid to bids@daytonohio.gov with IFB number in "Subject" line. All
supplemental documentation shall be included with the original.
BIDDER IS REQUESTED TO USE THE CITY'S BID FORM ENCLOSED AS NONE OTHER WILL BE ACCEPTED.
LEGIBLE INFORMATION MUST BE GIVEN IN THE SPACES PROVIDED.
A copy of the Bid Tabulation may be obtained by contacting the Procurement office and will be available online once the award has
been made.
All federal, state, and local laws regarding competitive bidding, anti-competitive practices, and conflict of interest shall be applicable to
this I.F.B.
Bids are to include all shipping costs to the point of delivery as indicated above.
The City of Dayton is exempt from payment of federal excise taxes and state retail sales taxes (Ohio Vendor's License No. 57-15847).
Multi-year orders are valid only if funds are available in succeeding years.
State Manufacturer and Model No. of items you are bidding and send DESCRIPTIVE LITERATURE on same with your bid. Any
brand names on our bid form are to establish quality levels and do not indicate preference.
The City of Dayton reserves the right to reject any or all bids, to waive any irregularities in a bid, or to accept the bid or bids which in
the judgment of proper officials, is to the best interest of the City.
The City of Dayton reserves the right to accept a part or parts of a bid unless otherwise restricted in the bid. If you are not in a
position to quote, advise to this effect so we may keep your name on our active bid list. We are not permitted to accept telephone
bids or Fax bids.
BIDDER'S PLEASE NOTE: Your signed equal opportunity "Affirmative Action Assurance" form (available at Human Relations
Council, 371 W. Second St., Suite 100, Dayton, Ohio 45402--Phone No. 937-333-1403) must be on file with the City of Dayton before
an order or contract can be issued. Please complete and return promptly to the Human Relations Council.

BID TO THE CITY OF DAYTON, OHIO
DIVISION OF PROCUREMENT
E-MAIL TO: bids@daytonohio.gov
Date: ___________ Buyer: John Finley - john.finleyjr@daytonohio.gov I.F.B. No. JF26014
Note: FOB Destination; all prices bid to the City shall include all fees of transportation including inside delivery.
Item Unit
No. QTY U/M Description Price
Trade-in of Surplus Police Equipment for Tactical Equipment
(no substitutions)
The City of Dayton shall receive an across the board discount of ______% off list pricing for related items not listed
herein. Manufacturer's price list for parts and supplies shall be presented with invoice to reflect discount to the City of
Dayton. Should there be different discount percentages for different manufacturers, please list all discounts with
manufacturer on a separate sheet.
Price to remain firm for the period through December 31, 2026. _____ YES ____ NO
If NO, for how long? ______________.
The City of Dayton is using P-Cards (Master Charge) for many low dollar purchases based on any Price
Agreement(s) in effect - please bid accordingly.
Do you accept Master Charge Cards? ______________
Bidder shall provide all product Summary and Specifications related to product(s) and Manufacturer's Warranty listed below with
your company's bid response.
BIDDER IS REQUESTED TO USE THE CITY'S BID FORM ENCLOSED AS NONE OTHER WILL BE ACCEPTED.
THE UNDERSIGNED HEREBY CERTIFIES THAT ITEMS FURNISHED AS A RESULT OF THIS BID WILL BE IN FULL ACCORDANCE WITH
THE CITY OF DAYTON SPECIFICATIONS APPLYING THERETO UNLESS EXCEPTIONS ARE STATED ABOVE.
"I certify the bidding entity complies with City of Dayton Ordinance #30829-09 and the City's Revised Code of General
Ordinances Section 35.70 through 35.74 regarding Living Wages." [ ] YES [ ] NO
All delivery costs are included in this quotation Bidding Company____________________________________
regardless of F.O.B. designation.
Address : ___________________________________________
Cash Discount Allowed:______% 10th Proximo.
Leave blank if your terms are Net 30 Days. ___________________________________________________
City State Zip Code
Delivery will be made within ________ calendar
days after receipt of order. ____________________________________________________
Email address to send Purchase Order to:
Prices quoted will remain firm for acceptance with-
in 90 calendar days after bid opening unless other- By:_________________________________________________
wise stated. (Please Print or Type) Name and Title
Signature: ___________________________________________
Phone No.__________________/FED. ID#_________________

BID TO THE CITY OF DAYTON, OHIO
DIVISION OF PROCUREMENT
E-MAIL TO: bids@daytonohio.gov
Date: ___________ Buyer: John Finley - john.finleyjr@daytonohio.gov I.F.B. No. JF26014
Note: FOB Destination; all prices bid to the City shall include all fees of transportation including inside delivery.
Item Unit
No. QTY U/M Description Price
Trade-in of Surplus Police Equipment for Tactical Equipment
NEW TACTICAL EQUIPMENT
1. 28 EA SilencerCo, Velos K Suppressor, 223
more or less Remington/5.56 NATO, 4.76" Long, 12.4 oz, $_________
17-4 Stainless Steel & Inconel 625 Construction, V-
Series Cerakote Finish, Black, Includes Internal
Charlie Flash Hider Front Cap, Charlie ASR
Mount, ASR Muzzle Device, Spanner Wrench,
and A Charlie Tool
Product #: SU5420
2. 6 EA Micro T-2 Red Dot Reflex Sight - No Mount $_________
more or less Product #: 200180
3. 7 EA Utility Tactical, FAST Micro, Red Dot Mount, $_________
more or less 2.26" Optical Height, Compatible with T1/T2
Footprints, Anodized Finish, Black
Product #: FST-MICB
SUBTOTAL $_________
SURPLUS POLICE EQUIPMENT
1. 25 EA Heckler & Koch UMP .45 $_________
2. 22 EA Rock River M4 $_________
3. 1 EA Penn Arms 37mm 6 Cylinder (Has rust) $_________
4. 1 EA Penn Arms 37mm 6 Cylinder $_________
5. 3 EA MOD .210/276 Single Launcher $_________
6. 1 EA Defense Tech Single Launcher $_________
7. 74 EA Heckler & Koch UMP .45 Magazines $_________
8. 48 EA Magpul 30 Round Magazine - TAN $_________
Bidding Company:______________________________________

BID TO THE CITY OF DAYTON, OHIO
DIVISION OF PROCUREMENT
E-MAIL TO: bids@daytonohio.gov
Date: ___________ Buyer: John Finley - john.finleyjr@daytonohio.gov I.F.B. No. JF26014
Note: FOB Destination; all prices bid to the City shall include all fees of transportation including inside delivery.
Item Unit
No. QTY U/M Description Price
Trade-in of Surplus Police Equipment for Tactical Equipment
SURPLUS POLICE EQUIPMENT
(CONTINUED)
9. 30 EA AR-15 30 Round Magazine - Steel $_________
10. 12 EA Trijicon MRO $_________
11. 15 EA FAB Defense Buttstock $_________
12. 5 EA Buffer Tube with Hogue Adapter $_________
13. 19 EA PRO-TECH Body Armor $_________
14. 10 EA United Shield PST (IIIA) Helmet $_________
15. 3 EA Halligan $_________
16. 2 EA Ram Bars $_________
17. 5 EA Streamlight TLR-1 $_________
18. 1 EA Streamlight TLR VIR $_________
19. 2 EA Streamlight PROTAC $_________
20. 2 EA Surefire M951 $_________
21. 23 EA Surefire M900 $_________
SUBTOTAL $_________
RESULTING NET COST TO THE CITY $_________
Bidding Company:______________________________________

City of Dayton, Ohio
Trade-in of Surplus Police Equipment for Tactical Equipment
IFB No. JF26014
July 2026
TRADE-IN REQUIREMENTS
* The successful bidder shall accept all listed trade-in property.
* Partial acceptance of the listed trade-in property is not permitted.
* Vendors shall assign an individual trade-in value to each listed item.
* Trade-in values shall be applied as a credit toward the purchase of the specified new equipment.
* The successful bidder shall possess all federal, state, and local licenses required to lawfully receive, transport,
possess, transfer, and dispose of the firearms and other regulated items included in this solicitation, and shall
comply with all applicable ATF requirements.

BID TO THE CITY OF DAYTON, OHIO
DIVISION OF PROCUREMENT
E-MAIL TO: bids@daytonohio.gov
Date: ___________ Buyer: John Finley - john.finleyjr@daytonohio.gov I.F.B. No. JF26014
Note: FOB Destination; all prices bid to the City shall include all fees of transportation including inside delivery.
DESCRIPTION
BID DOCUMENT
All bid shall be submitted as PDF via electronic submission to bids@daytonohio.gov. The City's email size can only accept
20meg limit for incoming e-mail message sizes (20meg includes e-mail itself and any attachments total). Should the bid
document be larger than this size your company will have to submit bid in several email documents. Should the bid be submitted
in multiple parts please designated in the "Subject", your bid response as multiple "Parts", i.e. IFB No. JF26014.
BID OPENING
The bid opening will be using ZOOM and the login information is:
Topic: Bid Opening- August 4, 2026 Time: 3:00 P.M. Eastern Time (US and Canada)
Join Zoom Meeting
https://us02web.zoom.us/j/6068939302?omn=87840660103
Meeting ID: 606 893 9302
One tap mobile
+13092053325,,6068939302# US
+13126266799,,6068939302# US (Chicago)
Dial by your location
* +1 309 205 3325 US
* +1 312 626 6799 US (Chicago)
* +1 646 931 3860 US
* +1 929 436 2866 US (New York)
* +1 301 715 8592 US (Washington DC)
* +1 305 224 1968 US
* +1 360 209 5623 US
* +1 386 347 5053 US
* +1 507 473 4847 US
* +1 564 217 2000 US
* +1 669 444 9171 US
* +1 669 900 6833 US (San Jose)
* +1 689 278 1000 US
* +1 719 359 4580 US
* +1 253 205 0468 US
* +1 253 215 8782 US (Tacoma)
* +1 346 248 7799 US (Houston)
Meeting ID: 606 893 9302
Find your local number: https://us02web.zoom.us/u/kcR8qdc7lz
Bidding Company:______________________________________

City of Dayton, Ohio
Trade-in of Surplus Police Equipment for Tactical Equipment
IFB No. JF26014
July 2026
REFERENCES FOR BIDDING COMPANY
List Company names, addresses, and telephone numbers for at least three references presently or previously
served by your Company for IFB No. JF26014. Do not use the City of Dayton as a reference.
Company Name:
Address:
Contact Person:
Telephone Number: Fax Number:
Email Address:
Company Name:
Address:
Contact Person:
Telephone Number: Fax Number:
Email Address:
Company Name:
Address:
Contact Person:
Telephone Number: Fax Number:
Email Address:

TERMS AND CONDITIONS
1. BILLING: All goods or services must be billed to THE CITY OF DAYTON, OHIO and at prices not exceeding those stated on the Purchase Order. If prices or terms do not agree with quotation,
notify the City of Dayton, Division of Procurement, immediately.
2. INVOICE: All invoices must be in duplicate and must be forwarded to the City of Dayton at the address shown on the Purchase Order. Each Purchase Order must be invoiced separately. Invoices
for partial shipments will be accepted; final invoice must indicate completion of order.
3. CASH DISCOUNTS: All cash discount terms will be effective from date of actual receipt and acceptance of the items purchased, or from receipt of correct and acceptable invoice, whichever is
later.
4. F.O.B.: Destination (City of Dayton, Ohio) with delivery to the specified Department at the specified street address. NO COLLECT FREIGHT SHIPMENTS WILL BE ACCEPTED. All
quotations are solicited won a delivered price basis. When, in rare instances, the City accepts a quotation not including all shipping charges, your claim for reimbursement must be itemized on
the invoice and supported with a copy of the original freight bill.
5. TAXES: The City of Dayton is exempt from payment of Federal excise taxes and State retail sales taxes. The City of Dayton's Federal Exemption Certificate is No. 31-73- 0546K and Ohio
Vendor's License No. is 57-15847. The Vendor is responsible for all Social Security taxes and Workers' Compensation contributions for the Vendor or any of the Vendor's employees.
6. DELIVERIES: All deliveries on this order must be in full accordance with specifications, properly identified with the Purchase Order number, and must not exceed the quantities
specified.
7. CANCELLATION: The City of Dayton reserves the right to cancel this order by written notice if the Vendor does not fulfill its contractual obligations with respect to timeliness and/or
quality.
8. DEFAULT PROVISIONS: In case of default by the Vendor, the City of Dayton may procure the items from other sources, and the Vendor shall be responsible for any excess costs occasioned
thereby.
9. NO VERBAL AGREEMENTS: The City of Dayton will be bound only by the terms and conditions of this order and will not be responsible for verbal agreements made by any other officer or
employee of the City of Dayton. The receipt of this purchase order does not indicate an authorization of fulfillment. Confirmation by City personnel must be received as indicated in the purchase
order before any orders are placed.
10. PATENT AND COPYRIGHT INFRINGEMENTS: It is hereby understood that by acceptance of this order, the Vendor agrees to defend, indemnify, and save harmless the City of Dayton,
Ohio, its officers, agents and employees from any and all loss, costs or expense on account of any claim, suit or judgment as a result of, caused by, or incidental to any patent, copyright or trademark
infringement and/or royalty, actual or claimed, because of the use or disposition by said City of any article enumerate on this order and sold to said City pursuant to this order.
11. APPLICABLE LAWS: The Vendor warrants that the items and their production or completion shall not violate any federal, state or local laws, regulations or orders.
12. INSPECTION: The City of Dayton may inspect the items ordered hereunder during their manufacture, construction and/or preparation at reasonable times and shall have the right to inspect
such items at the time of their delivery and/or completion.
13. WARRANTY: The Vendor warrants all items delivered hereunder to be free from defects of material or workmanship, to be of good quality, and to conform strictly to any specifications,
drawings or samples which may have been specified or furnished by the City of Dayton, and the Vendor further warrants that the Vendor will have good title to the items free and clear of all liens
and encumbrances and will transfer such title to the City of Dayton. Said warranties shall not negate or limit any implied warranties of merchantability or fitness. This warranty shall survive any
inspection, delivery, acceptance or payment by the City of Dayton.
14. RISK OF LOSS: Title and risk of loss to and with respect to the items shall remain in the Vendor until the items in a completed state have been delivered to and accepted by the City of Dayton
or to an agent or consignee duly designated by the City of Dayton at the location specified on the face hereof, items which are to be shipped shall be shipped F.O.B. destination unless otherwise
specified by the City of Dayton. A packing slip must accompany each such shipment and if a shipment is to a consignee or an agent of the City of Dayton, a copy of the packing slip shall be
forwarded concurrently to the City of Dayton. If no such packing slip is sent, the count or weight by the City of Dayton or its agent or consignee is agreed to be final and binding on the Vendor with
respect to such shipment.
15. SAVE HARMLESS: To the fullest extent permitted by law, the Vendor shall protect, defend, indemnify and hold free and harmless the City of Dayton, its agents, consignees, employees, and
representatives from any and all claims, damages, losses claims of loss, causes of action, penalties, settlements, costs, liabilities and expenses of any kind, including but not limited to attorney's fees,
arising out of any acts or omissions of the Vendor; its officers and employees, including but not limited to temporary employees that the Vendor provides to the City of Dayton who may be trained or
controlled by the City of Dayton to any degree; consultants; agents; and, subcontractors of any tier used in any way to provide the goods or services for this purchase order.
16. FORCE MAJEURE: Neither the City nor Vendor shall be considered in default of these Purchase Order Terms and Conditions for delays in performance caused by circumstances beyond the
reasonable control of the non-performing party. For purposes of these Terms and Conditions, such circumstances include, but are not limited to: abnormal weather conditions; floods; earthquakes;
fire; epidemics; wars, riots, and other civil disturbances; strikes, lockouts, work slowdowns, and other labor disturbances; sabotage; judicial restraint; and inability to procure permits, licenses, or
authorization from any local, state, or federal agency for any of the supplies, materials, accesses, or services required to be provided by either the City of Consultant under this Agreement. Should
such circumstances occur, the non-performing party shall, within a reasonable time of being prevented from performing, give written notice to the other party describing the circumstances preventing
continued performance and the efforts being made to resume performance under this Purchase Order.
17. INSURANCE: If requested by the City of Dayton, the Vendor shall maintain policies of liability insurance of such types and such amounts and with such companies as may be designated by
the City of Dayton, which policies shall be written so as to protect the City of Dayton and the Vendor from the risks enumerated in Section 15. Such policies of insurance shall not be cancellable
except upon thirty (30) days written notice to the City of Dayton and proof of such insurance shall be furnished by the Vendor to the City of Dayton. In addition, such policies shall protect all
subcontractors of the Vendor. The Vendor agrees to make prompt written report to the insurance company involved of all accidents, occurrences, injuries or losses which may occur and of any and
all claims made against the persons insured under said policies.
18. SPECIFICATIONS CONFIDENTIAL: Any specifications, drawing, notes, instructions, engineering notices or technical data referred to in this Purchase Order shall be deemed to be
incorporated herein by reference the same as if fully set forth. The City of Dayton shall at all times retain title to all such documents and the Vendor shall not disclose such to any party other than
the City of Dayton or a party duly authorized by the City of Dayton. Upon the City of Dayton's request or upon completion and delivery of the items the Vendor shall promptly return all such
documents to the City of Dayton.
19. EXAMINATION OF PREMISES: If work is to be performed hereunder on the premises of the City of Dayton, the Vendor represents that it has examined the premises and any specifications
or other documents furnished in connection with the items and that it has satisfied itself as to the condition of the premises and site and agrees that no allowance shall be made in respect of any error
as to such on the part of the Vendor.
20. CLEANING OF PREMISES: If work is to be performed hereunder on the premises of the City of Dayton, the Vendor shall at all times keep the premises free from accumulation of
waste material or rubbish. At the completion of the items the Vendor shall leave the premises and the items broom-clean.
21. EQUAL EMPLOYMENT OPPORTUNITY, R.C.G.O. Sec. 35.14: (a) The Vendor agrees that it will not discriminate against any employee or applicant for employment because of race, color,
religion, sex, sexual orientation, gender identity, ancestry, national origin, place of birth, age, marital status, or handicap with respect to employment, upgrading, promotion or transfer, recruitment
or recruitment advertising, lay-off, termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. (b) It is expressly agreed and understood by Vendor
that R.C.G.O. Sec. 35.14 constitutes a material condition of this contract as fully as if specifically rewritten herein and that failure to comply therewith shall constitute a breach thereof entitling the
City to terminate the contract at its option.
22. AGREEMENT TO BE EXCLUSIVE: This Purchase Order contains the entire agreement between the parties and supersedes all other agreements between them. The parties acknowledge and
agree that neither of them has made any representation with respect to the subject matter of this Purchase Order or any representation inducing the execution and delivery of this Purchase Order except
such representations as are specifically set forth herein, and each party acknowledges that it has relied on these representations in connection with its dealings with the other.
23. GOVERNING LAW: This Purchase Order, the performance under it, and all suits and special proceedings under it shall be construed in accordance with the laws of the State of Ohio. In any
action, special proceeding or other proceeding that may be brought arising out of, in connection with, or by reason of this Purchase Order, the laws of the State of Ohio shall be applicable and shall
govern to the exclusion of the laws of any other forum, without regard to the jurisdiction in which the action or special proceeding may be heard.
24. ADDITIONAL RIGHTS: Any rights or remedies granted to the City of Dayton in any part of this Purchase Order shall not be exclusive of, but shall be in addition to, any other rights or remedies
granted in another part of this Purchase Order and any other rights or remedies that the City of Dayton may have at law or in equity in any such instance.
25. PRODUCT MANUFACTURE LABOR STANDARDS: Products and services provided for in this Purchase Order cannot be produced under "Sweatshop" Conditions as defined in Informal
Resolution No. 301-97 as adopted by the Commission of the City of Dayton. The City of Dayton encourages vendors, contractors, Enterprise Zone employers and other organization doing business
with the City of Dayton to use their best efforts to pay a living wage to their employees in accordance with Informal Resolution No. 321-98 as adopted by the Commission of the City of Dayton.
26. CONTRACTOR: Contractor acknowledges its employees are not public employees for purpose for Ohio Public Employees Retirement System ("OPERS") membership.
27. VENUE: Vendor agrees that all suits or special proceedings pertaining to or arising from this Purchase Order shall be brought exclusively in a court of competent jurisdiction located in
Montgomery County, Ohio. Vendor hereby consents and submits to the exclusive jurisdiction of such court. Vendor agrees that no legal action, suit or proceeding with respect to this Purchase Order
may be brought in any other forum.
28.VENDOR WARRANTS AND GUARANTEES THAT: (a) all services provided shall be performed in a timely, efficient, and professional manner; (b) all personnel assigned to perform services
shall have the necessary skill and training; and (c) services shall be performed in a manner consistent with the standard of care in the industry. The Vendor shall fully warrant and guarantee the
effectiveness, fitness for purpose intended, quality and merchantability of any services or work performed. This shall be in addition to any other warranty, guarantee, or remedy provided by law or
otherwise.
29. TERMINATION: The City may, at any time, upon twenty days written notice to the contractor, terminate this purchase order in whole or in part for the City's convenience and without cause. The
contractor shall not be entitled to any profit or overhead for the materials, equipment or services not performed.
T&C Revision Date: 20 November 2024

AFFIRMATIVE ACTION ASSURANCE
NOTE: Prior to any award on this bid the vendor(s) must have a current
Affirmative Action Assurance Form on file and approved by the City
of Dayton Human Relations Council.
If you have a current approval, please enclose a copy with your bid.
If you do not have a current approval, or are not sure if you do, please
contact the Human Relations Council at 937-333-1403 or by
following instructions at link:
Affirmative Action Assurance | Dayton Human Relations Council
If you are notified by the City of Dayton that your company does not
have a current "AAA" approval, you will have five (5) working days
to obtain the approval. Failure to obtain this approval within five (5)
working days may be cause for rejection of your bid(s).

CITY OF DAYTON, OHIO
PROCUREMENT ENHANCEMENT PROGRAM (PEP) PREFERENCE FORM
Ordinance #31023-10 (hereinafter referred to as 'the Ordinance') passed by the Dayton City Commission provides for a Dayton
Local Business and MBE, WBE or SBE Bidder Preferences for Goods and Services purchased by the City of Dayton as defined
in section 35.42 of the Revised Code of General Ordinance (R.C.G.O.). Excerpts of the ordinance are provided for your
information.
The rules and regulations adopted by the City for the administration of this ordinance require that bidders claiming Preference
complete this form for each bid.
Failure to properly complete and return this form may result in not being qualified to receive preference under the Ordinance.
If I am a: 1. Local and certified MBE, WBE or SBE 10%
or 2. Local and not certified MBE, WBE or SBE 5%
or 3. Certified and not local 5%
If my bid is within the above percentage of the lowest bid submitted, I agree to reduce my bid to match the lowest bid
Check one [ ] Yes [ ] No [ ] Please contact me
PREFERENCE CLAIMED - check one or both [ ] Dayton Local Bus. [ ] Certified MBE, WBE, or SBE
NOTE if claiming local preference, the business location must meet the definition of a Dayton Local Business.
NOTE if claiming Certified M/W/SBE preference, the business must submit a current copy of the City of Dayton HRC certification
letter with the bid.
BUSINESS NAME: __________________________________________________________________________
BUSINESS ADDRESS: _______________________________________________________________________
COUNTY: __________________________ STATE: _____________________ ZIP CODE: _________________
FEDERAL I.D. NO.: __________________________________________________________________________
If incorporated. If a sole proprietorship, use Social Security number of owner.
TESTIMONY AND AUTHORIZATION
The undersigned, on behalf of the aforementioned business concern, hereby authorizes the City of Dayton Department of
Finance, Division of Taxation to provide proof of situs pursuant to the Ordinance (#31023-10), to the city of Dayton Division of
Purchasing. In so doing, I authorize the Division of Taxation to disclose such records as may be necessary to establish
qualifications for local preference as required by the Ordinance or any subsequent rules and regulations adopted in the
administration of the Ordinance. I, on behalf of the aforementioned business concern, hereby release the City of Dayton and
its officers, employees, or agents from any and all liability for the disclosure of any information establishing these qualifications.
If applying as a Dayton Local Business, I attest to the fact that the business is physically located within the corporate limits and
boundaries of the City of Dayton, Ohio. By affixing my signature to this form, I also attest that I am a duly authorized agent of
the aforementioned business concern.
__________________________________________ __________________________________________
Type or Print Agent Name Agent Signature and Date
Form LP29572-98 Rev 10-7-10