01-Affirmation_and_Disclosure_Form_3-4-22.pdf
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- Solicitation number
- SRC0000035299
- Issued by
- Mahoning County, Ohio
About this file
This is an Affirmation and Disclosure Form used by the Ohio Department of Rehabilitation and Correction for the commercial overhead door installation project at the OPI Glove Factory within Madison Correctional Institution in London, Ohio. The form requires bidders to identify all locations where services will be performed, where state data will be located, and the principal business locations of the contractor and any subcontractors. A mandatory site visit is scheduled for December 2, 2025, at 1:00 p.m., with interested bidders required to contact John Lyon by 12:00 p.m. on November 28, 2025, to coordinate gate passes. Bid submissions are due December 10, 2025, at 4:00 p.m. Columbus time, with project completion targeted for January 15, 2026. The contract term extends from award through project completion, with potential renewal by mutual agreement not to exceed four years total.
The form affirms contractor compliance with Executive Orders prohibiting offshore service performance, locating state data offshore, and purchasing from Russian institutions or companies. Contractors and subcontractors must disclose all service performance locations and state data locations before, during, and after contract execution, with immediate notification required for any changes in location. The State reserves the right to immediately terminate the contract if services are performed outside the United States without a duly signed waiver. All work must be performed within the United States, and contractor personnel accessing the correctional facility must undergo background checks. Insurance requirements include workers' compensation and commercial general liability coverage with minimum limits of $1,000,000 annual aggregate and $500,000 per occurrence. Payment terms are Net 30 through electronic funds transfer under a flat-rate agreement covering both materials and labor.
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Text version
AFFIRMATION AND DISCLOSURE FORM
Rev. 3/22 Page 1 of 2
Contractor affirms that Contractor has read and understands the applicable Executive Orders regarding the prohibitions of performance of offshore services, locating State data offshore in any way, or purchasing from Russian institutions or companies.
Contractor shall provide all the name(s) and location(s) where services under this Contract will be performed and where data is located in the spaces provided below or by attachment. Failure to provide this information may result in no award. If the Contractor will not be using subcontractors, indicate “Not
Applicable” in the appropriate spaces.
1. Principal location of business of Contractor:
(Address) (City, State, Zip)
Name/Principal location of business of subcontractor(s):
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
Name/Location where services will be performed by subcontractor(s):
Rev. 3/22 Page 2 of 2
3. Location where state data will be located, by Contractor:
Name/Location(s) where state data will be located by subcontractor(s):
Contractor affirms, understands, and agrees that Contractor and its subcontractors are under a duty to disclose to the State any change or shift in location of services performed by Contractor or its subcontractors before, during and after execution of any contract with the State. Contractor agrees it shall so notify the
State immediately of any such change or shift in location of its services. The State has the right to immediately terminate the contract, unless a duly signed waiver from the State has been attained to perform the services outside the United States.
On behalf of the Contractor, I acknowledge that I am duly authorized to execute this Affirmation and
Disclosure Form and have read and understand that this form is a part of any Contract that Contractor may enter into with the State and is incorporated therein.
By:
Contractor
Print Name:
Title:
Date:
File details come from the government source that posted it. Updated .