1-Signed_Affirmation_and_Disclosure.pdf
PDF 385 KB Posted
- Attached to
- Competitive Selection OH|DOT06326-4
- Contract number
- DOT06326-4
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form from Path Master, Inc., signed on July 29, 2025, for a contract with the State of Ohio, specifically involving the Ohio Department of Transportation (ODOT). The form addresses compliance with Executive Orders 2022-02D and 2019-12D, which prohibit the purchase of services from Russian companies and offshore service providers. The contractor affirms that all services will be performed within the United States, specifically at their principal business location in Twinsburg, Ohio.
The form indicates that Path Master, Inc. has no subcontractors and will perform all services and maintain all state data at 1960 Midway Drive in Twinsburg, OH, 44087. The document emphasizes the contractor's commitment to not sending, accessing, or storing state data outside the United States without a signed waiver from the state. The contractor, represented by Halle Van Scoy (Vice President), agrees to immediately notify the state of any changes in service locations and understands that the state can terminate the contract if services are performed outside the United States without proper authorization.
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Other files
| File | Type | Posted |
|---|---|---|
| 063-26spec.pdf | ||
| 1-063-26pricing_FINAL.xlsx | XLSX spreadsheet | |
| Signature__4___1___002_.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:
(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:
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
1960 Midway Drive Twinsburg, OH, 44087
N/A N/A
N/A N/A
1960 Midway Drive Twinsburg, OH, 44087
N/A N/A
N/A N/A
1960 Midway Drive Twinsburg, OH, 44087
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