1_Standard Affirmation & Disclosure Form_fillable PDF Form.pdf1_Standard Affirmation & Disclosure Form_fillable PDF Form.pdf

PDF 267 KB Posted Sep 23, 2026

Attached to: PWC Mosquito ADA Kayak Launch
Solicitation number: SRC0000042085
Issued by: Ohio

About this file

Written by GovTribe AI · Sep 24, 2026

This is an Affirmation and Disclosure Form for state contracts in Ohio, specifically related to the Mosquito Lake State Park ADA Kayak Launch project. The form requires contractors and their subcontractors to affirm and disclose that all services will be performed within the United States and that all state data will remain located within the United States unless the state provides a duly signed waiver. Contractors must provide detailed information regarding their principal business location, all locations where services will be performed, and all locations where state data will be stored or maintained. The form explicitly states that failure to provide complete location information may result in no contract award.

Contractors and subcontractors are obligated to immediately notify the state of any changes or shifts in service locations or data locations before, during, or after contract execution. The state retains the right to immediately terminate the contract if services are performed outside the United States without prior written waiver authorization. The form must be signed by a duly authorized representative of the contractor and becomes an incorporated component of any executed contract with the state. The document serves as a binding affirmation that the contractor understands and agrees to these geographic restrictions and disclosure requirements as a condition of contract eligibility and performance.

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3_ DAS Terms and Conditions.pdf3_ DAS Terms and Conditions.pdf	PDF	Sep 23, 2026

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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: __________________________________

Address:

City State Zip:

Name:

Address City State Zip:

Name_2:

Address City State Zip_2:

Address_2:

City State Zip_2:

Name_3:

Name_4:

Address City State Zip_3:

Address City State Zip_4:

Address_3:

Address City State Zip_5:

Name_5:

Name_6:

Name_7:

Name_8:

Name_9:

Address City State Zip_6:

Address City State Zip_7:

Address City State Zip_8:

Address City State Zip_9:

Address City State Zip_10:

File details come from the government source that posted it. Updated Sep 24, 2026.