04-Affirmation and Disclosure Form_3-4-22.pdf
PDF 80 KB Posted
- Attached to
- 16â Tandem Axle Utility Trailer State and local contract opportunity
- Solicitation number
- SRC0000031032
- Issued by
- Sandusky County, Cincinnati City, Ohio
About this file
This document is an Affirmation and Disclosure Form that requires contractors to affirm compliance with Executive Orders regarding offshore services and data location restrictions. The form mandates that contractors disclose the principal location of their business, the specific locations where contract services will be performed, and the locations where state data will be stored, including details for both the primary contractor and any potential subcontractors. Contractors must provide complete address information for all business and service locations, with a warning that failure to provide this information may result in no contract award.
The form emphasizes ongoing disclosure requirements, stating that contractors and subcontractors have a continuous duty to notify the state of any changes in service or data location before, during, and after contract execution. The state retains the right to immediately terminate the contract if services are performed outside the United States, unless a formal waiver is obtained. The document includes signature lines for the contractor to acknowledge understanding of these terms, with space for the contractor's name, title, and date of execution. The form is marked as revised in March 2022 and spans two pages, creating a comprehensive location and compliance declaration mechanism for state contract opportunities.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Standard_T_C_04-10-23.pdf | ||
| OPERS Independent Contractor Form_fillable PDF Form.pdf | ||
| THSF Utility Trailer Ohio Buys ITB.pdf | ||
| Ohio Buys Information.pdf |
On GovTribe
Work with this file on GovTribe
- 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 .