01-Affirmation_and_Disclosure_Form_3-4-22.pdf
PDF 85 KB Posted
- Attached to
- DRC - 5000 LB Electric Forklift with Trade-In Value for OPI SCI Janitorial Warehouse - DRC260102
- Solicitation number
- SRC0000036413
- Issued by
- Fairfield County, Ohio
About this file
This is an Affirmation and Disclosure Form required by the State of Ohio for contractors bidding on state and local contract opportunities. The form mandates that contractors disclose their principal business location, all locations where services will be performed, and all locations where state data will be stored. Contractors must affirm compliance with Executive Orders prohibiting offshore service performance, offshore data storage, and purchases from Russian institutions or companies. The form requires disclosure of all subcontractor information using the same three categories: principal business location, service performance location, and data storage location. Contractors must indicate "Not Applicable" if no subcontractors will be used.
The form establishes that contractors have an ongoing duty to disclose any changes or shifts in service performance locations before, during, and after contract execution, with immediate notification required to the state. Failure to provide complete location information may result in no award of the contract. The state reserves the right to immediately terminate any contract if services are performed outside the United States unless the contractor obtains a duly signed waiver from the state. The form must be executed by an authorized representative of the contractor and is incorporated as a binding part of any resulting contract with the state.
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| DRC260102_5000 lb Electric Forklift for OPI SCI Warehouse.pdf | ||
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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 .