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be disqualified. An employer may also be disqualifietl for failing
<br />to verify by invoice/receipt antl check copy that the grant money
<br />was utilized for the intended purposes. Disqualification will
<br />result in the termination of BWC's obligations under this
<br />agreement. BWC reserves the right to recover the
<br />misappropriated grant monies by the following methods:
<br />billing the employer for the grant money received,
<br />forwarding the employer's information to the Ohio
<br />Attorney General for collection, by set-aff, recoupment
<br />or other administrative, civil and/or legal remedy.
<br />OHIO ELECTIONS LAW: Employer certifies that, as applicable, no
<br />party listed in Division fl?11?(a),1J?(1)(a), (Y)1111a), or (Z)I1)la) of Section
<br />351713 of the Revised Code, induding the spouse of such party, and
<br />any minor child of such party between ayes seven (7) and seventeen
<br />(17) years, has matle, as an individual, within the two previous calendar
<br />years, one or more contributions totaling in excess of $1,000.00 to the
<br />carripaign committee of the Governor or lieutenant governor of Ohio,
<br />or to the campaign committee of ai}y candidate for Governor or
<br />lieutenant governor.
<br />Employer certifies that, as applicable, no combination of parties listed
<br />in Division (1)(1)(b), IJI(1)Ibl, IY111Ub), or (Z)(1)1b) ofi Section 3517.13 of
<br />the Revised Code, including the spouse of such party, any minor child
<br />of such party between ages seven (7) and seventeen (17) years, and
<br />any affiliated political action committee, has made, within the two
<br />previous calendar years, one or more contributions totaling in excess
<br />of $2,000.00 to the campaign committee of the Governor or lieutenant
<br />governor of Ohio, or to the campaign committee of any canditlate for
<br />Governor or lieutenant governor.
<br />Employer certifies tfiat, as applicable under Division (I)(4)(a), (J4)Ia1,
<br />(Y?14)Ia1, or (Z)(4)Ia) of Section 3517.13 of the Revised Code, no political
<br />action committee affiliated with Employer has made, within the two
<br />previous calendar years, one or more contributions totaling in excess
<br />of $2,000.00 to tlie campaign committee ofi the Gavernor or lieutenant
<br />governor of Ohio, or to the campaign committee of any candidate for
<br />Governor or lieutenant governor.
<br />Knowingly making a fatse statement as to any certification abave
<br />required under Division (I)131, (J)(3), (Y)(3), or (Z)(3) of Section 3517.13
<br />of the Revised Code is a felony of the fifth tlegree under Ohio law, and
<br />shall result in rescission of this contract.
<br />Beginning on the date this contract is awarded and extE;nding until
<br />one year followiny the conclusion of the contract, no party or
<br />com6ination uf parties listed in Division (I), (J), (Y), or (Z) of Section
<br />3517.13 of the Revised Code, as applicable, shall make any contributions
<br />to the campaign committee of the Governor or lieutenant governor oi
<br />Ohio, or to the campaign committee of any candidate for Governor or
<br />lieutenant yovernor, that are prohibited under Section 3517.13 of the
<br />Revised Code.
<br />CONFLICTS Of INTEREST AND ETHICS COMPLIANCE
<br />CERTIFICATION: Employer affirms that it presently has no interest
<br />and shall not acquire any interest, direct or indirect, which would
<br />conflict, in any manner or tlegree, with the performance of services
<br />which are required to be performed under any resulting Contract. In
<br />addition, Employer affirms that a person who is or may become an
<br />agent of Employer, not having such interest upori execution of this
<br />Contract shall likewise advise the 8ureau in the event it acquires such
<br />interest during the course of this Contract.
<br />Employer agrees to atlhere to all ethics laws contained in Chapters
<br />102 and 2921 of the Ohio Revised Code governing ethical behavior,
<br />understands that such provisions apply to persons doing or seeking
<br />to do business with the Bureau, antl agrees to act in accordance with
<br />the requirements of such provisions; and warrants that it has not paid
<br />and will not pay, has not given and will not give, any rernuneration or
<br />thing of value directly or indirectly to the Bureau or any of its board
<br />members, officers, employees, or agents, or any third party in any of
<br />the engagements of this Agreement or otherwise, including, but not
<br />limited to a finder's fee, cash solicitation fee, or a fee for consulting,
<br />lobbying or otherwise.
<br />In accordance witli Executive Order 2007-01 S, Employer or 6rantee,
<br />by signature on this document, certifies:(1 ) it has reviewed and
<br />understantls Executive Order 2007-01 S, (Z) has reviewetl and
<br />understands the Ohio ethics and contlict of interest laws, and 131 will
<br />take no action inconsistent with those laws antl this order. The
<br />Employer or Grantee understands that failure to comply with Executive
<br />Order 2007-01 S is, in itself, grounds for termination of this contract
<br />or grant and may result in the loss of other contracts or grants with
<br />the State of Ohia
<br />By my signature, I agree to fully comply with the terms and conditions of the program and utilize all monies solely
<br />for the purposes intended. I further understand that I may be subject to civil, cnminal and/or administrative penalties
<br />as the result of any false, fictitious and/or fraudulent statements made and/or if funtls are misappropriated and/or
<br />utilized for purchases anc}/or services that are not associated with the program.
<br />MODIFICATIONS. The parlies rnay, in writing and by inutual ayreemenl, amend, modify, sup lement or rescind the terms of this ayfreement
<br />r
<br />IN WITNESS WHEREOF, the parties hereunro affir, their sic?natures this day of 0 , 200
<br />Date Month
<br />Employer's Full Legal Name
<br />Federal Tax I.D.
<br />City of North Olmsted
<br />34-6002048
<br />Tltle MayO - State of Ohio, Bureau of Workers' Compensation
<br />Signature ?' _ SaietyGrant$ DFWP/DF-E/ 2006 RSP July 10,2007
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