Specifications

SECURITY CAMERA SYSTEM UPGRADE AND REPLACEMENT
FOR MONTGOMERY COUNTY DETENTION CENTER
CONSTRUCTION CONTRACT AGREEMENT C-9
EXEMPTION CERTIFICATE (Construction Contract)
Divided Contract Amount: Identification of Contract as will
Tangible personal appear on orders to be exempted:
property
Contract/Resolution No.______________
b. Labor, etc.
Dated _______________________
c. Total
Work to be completed
The undersigned hereby certifies that the articles of tangible personal property purchased under this certificate
were purchased for incorporation into:
( ) A structure or improvement to real property under a construction contract with the state of Ohio or a
political subdivision thereof.
( ) A house of public worship or religious education. A building used exclusively for charitable purposes
under a construction contract with a nonprofit organization operated exclusively for the relief of poverty, the
improvement of health through the alleviation of illness, disease or injury, or the promotion of education by
an institution of learning which maintains a faculty of qualified instructors, teaches regular continuous courses
of study and confers a recognized diploma upon completion of a specific curriculum.
( ) A structure or improvement to real property which is accepted for ownership by this state or any of its
political subdivisions at the time of completion of such structures or improvements.
This certificate shall be considered a part of each order for the specific contract identified above and shall be
retained by the vendor. The certificate must be signed by both the Contractor and the contractee.
Contractor: Contractee: Montgomery County, Ohio, Board
of County Commissioners
By: By: _________________________________
Title: ____________________________________ By: _________________________________
Date: ____________________________________ By: _________________________________
OR
By: _________________________________
Deborah A. Feldman
Administrator, Montgomery County, Ohio
Subcontractor: ____________________________
By: _____________________________________ Name of political subdivision
if improvement to be accepted
Title: ____________________________________ by one: Montgomery County, Ohio
Address: _________________________________
Date: ____________________________________