04-Affirmation and Disclosure Form_3-4-22 (1).pdf
PDF 84 KB Posted
- Attached to
- Locksmith OVH-S
- Solicitation number
- SRC0000021322
- Issued by
- Erie County, Ohio
About this file
This document is an Affirmation and Disclosure Form for a state and local contract opportunity in Ohio. The form requires the contractor to disclose the location(s) where services will be performed and where state data will be located, including any use of subcontractors. The contractor must also affirm their understanding of applicable Executive Orders regarding the prohibition of offshore services and purchasing from Russian institutions. The contract opportunity is for a Locksmith to complete in-house work order submissions for the Ohio Veterans Home in Sandusky. No additional details about the specific products, services, quantities, or timeline for the contract are provided in this document.
The form indicates that the contractor must disclose any change or shift in the location of services performed before, during, and after the contract execution. The State reserves the right to terminate the contract if services are performed outside the United States without a signed waiver. Pricing terms, set asides, funding sources, and other salient commercial details are not included in this particular document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| SOW Locksmith.pdf | ||
| Terms and Conditions.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .