1-2025_Affirmation_and_Disclosure_signature.pdf
PDF 140 KB Posted
- Attached to
- Competitive Selection OH|DOT11526-1
- Contract number
- DOT11526-1
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form from the State of Ohio, specifically involving the Ohio Department of Transportation (ODOT), executed by Goodin Building located at 5410 State Street in Albany, Ohio 45710. The form addresses compliance with Executive Orders 2022-02D and 2019-12D, which prohibit state agencies from purchasing services from Russian companies or institutions and offshore service providers. The contractor affirms that all services will be performed within the United States, with services to be conducted at various locations in Ohio, and state data to be located at the company's primary address in Albany.
The form does not specify specific goods or services under contract, but indicates that the contractor (Goodin Building) and its potential subcontractor (John P Goodin) will perform services at various Ohio locations. The document emphasizes strict requirements about service locations, data storage, and geographical restrictions, with the state reserving the right to immediately terminate the contract if these conditions are not met. While no specific contract value, pricing terms, or option periods are detailed in this document, it serves as a critical compliance and disclosure mechanism ensuring that state-contracted work adheres to specific geographical and geopolitical guidelines.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-General_maintenace_2025_115-26_Pricing_2025-04-02.xlsx | XLSX spreadsheet | |
| Signature.pdf | ||
| 115-26_Specs_2025-04-02.pdf | ||
| ODOT_Terms___Conditions_with_excel_pricing.pdf |
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Text version
AFFIRMATION AND DISCLOSURE FORM
By the signature affixed hereto, the Contractor affirms and understands that if awarded a contract, both the Contractor and any of its subcontractors shall perform no services requested under this Contract outside of the United States, not allow State data to be sent, taken, accessed, tested, maintained, backed-up, stored or made available remotely(located) outside of the United States unless a duly signed waiver from the State has been attained.
The 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.
EXPENDITURE OF PUBLIC FUNDS ON SERVICES PERFORMED BY RUSSIAN COMPANIES OR INSTITUTIONS.
The Contractor affirms to have read and understands Executive Order 2022-02D and shall abide by those requirements in the performance of this Contract. Pursuant to this Executive Order, all state agencies are prohibited from the purchase of services from Russian companies or institutions. This prohibition is in addition to and expands upon Executive Order 2019-12D which generally precludes the purchase of offshore services by the State of Ohio. Notwithstanding any other terms of this Contract, ODOT reserves the right to recover any funds paid for services the Contractor performs in Russia in violation of this Executive Order. ODOT does not waive any other rights and remedies provided to ODOT in this Contract.
The Contractor agrees to complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, to abide with Executive Order 2022-02D, which is incorporated and becomes a part of this Contract, affirming no services of the Contractor or its subcontractors under this Contract will be performed in Russia.
1. Principal location of business of Contractor:
5410 State Street__________________ ____Albany, Ohio 45710______ (Address) (City, State, Zip)
Name/Principal location of business of subcontractor(s):
John P Goodin 5410 State Street Albany, Ohio 45710 (Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
Various locations in Ohio (Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Various locations in Ohio (Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
5410 state Street Albany, Ohio 45710
(Address) (City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
Unknown at this time (Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
Contractor also 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 by the Contractor 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.
(AN ORIGINAL SIGNATURE IS REQUIRED)
Company Name: _______Goodin Building__
Signature: __________________________________
Print Name: ___John P Goodin_________________
Title: __________Owner_______________________
Date: _________April 23, 2025__________________
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