1_Standard Affirmation & Disclosure Form_fillable PDF Form.pdf
PDF 267 KB Posted
- Attached to
- PWC Dredge Crane Rental Shawnee State Park
- Solicitation number
- SRC0000037243
- Issued by
- Stark County, Ohio
About this file
This is an Affirmation and Disclosure Form required by the State of Ohio for the crane rental contract opportunity at Shawnee State Park. The form establishes mandatory compliance requirements for contractors and their subcontractors regarding the geographic location of service delivery and data management. Contractors must affirm that all services will be performed within the United States and that all state data will be kept within U.S. boundaries unless the state provides a signed waiver. The form requires contractors to disclose the principal business location, all locations where services will be performed, and all locations where state data will be stored, with provisions for multiple subcontractor information entries. The contract opportunity itself concerns a one-day crane rental on March 23, 2026, at Shawnee State Park in Ohio, requiring an all-terrain crane capable of lifting 73,000 pounds with three picks across a 25-foot radius with no overhead obstructions for offloading dredge equipment.
Contractors must provide complete location information at the time of bidding, with incomplete submissions potentially resulting in contract disqualification. The form imposes an ongoing disclosure obligation requiring contractors to immediately notify the state of any changes or shifts in service locations before, during, or after contract execution. The state retains the right to terminate the contract immediately if services are performed outside the United States without prior written waiver approval. The bid should be structured on a port-to-port basis for crane services. Failure to comply with these affirmation and disclosure requirements constitutes a material contract provision.
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Other files
| File | Type | Posted |
|---|---|---|
| 3_ DAS Terms and Conditions.pdf | ||
| 2_ Addendum to Bid Quote Base Template (Non-Federal Funds)_Rev. 2025 11 28_NO GUIDANCE.docx | DOCX document | |
| 6_OhioBuys+Fact+Sheet+for+Bidders_Suppliers (1).pdf | ||
| RFQ Dredge Crane Rental Shawnee State Park.docx | DOCX document |
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Text version
Version 2/20 Page 1 of 2
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, nor 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
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:
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Version 2/20 Page 2 of 2
3. Location where state data will be located, by Contractor:
(Address) (Address, City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
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.
By: __________________________________ Contractor
Print Name: ___________________________
Title: __________________________________
Date: __________________________________
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