1-Affirmation_and_Disclosure_-_OhioDOT_-_IRS_Executed.pdf
PDF 111 KB Posted
- Attached to
- Competitive Selection OH|DOT12626-1
- Contract number
- DOT12626-1
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form from Impact Recovery Systems, located in San Antonio, Texas, pertaining to a contract with the Ohio Department of Transportation (ODOT). The form specifically addresses compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions, and reinforces previous restrictions on offshore service procurement.
The form confirms that all services and state data will be performed and maintained exclusively within the United States at the company's San Antonio address, with no subcontractors involved. The contractor explicitly affirms that no services will be performed in Russia, and ODOT reserves the right to recover any funds paid for services that violate this requirement. The document is signed by the company's president, Greg Hannah, with an execution date of 9/18/2025, and serves as a legally binding disclosure of the contractor's service locations and commitment to maintaining data and service boundaries within the United States.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-126-26pricing_-_Impact_Recovery_Systems.xlsx | XLSX spreadsheet | |
| 126-26spec.pdf | ||
| ODOT_Co-Op_Program_Information__12_.pdf | ||
| Signature__38_.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 affinns 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 Fonn, 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:
4955 Stout Dr. San Antonio, TX 78219
(Address) (City, State, Zip}
Name/Principal location of business of subcontractor(s}:
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
4955 Stout Dr. San Antonio, TX 78219
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s}:
(Name)
(Name)
3. Location where state data will be located, by Contractor:
4955 Stout Dr.
(Address}
(Address, City, State, Zip)
(Address, City, State, Zip}
San Antonio, TX 78219
(City, State, Zip)
NA
File details come from the government source that posted it. Updated .