_247A-24_Truck_Mounted_Spreaders_-_Rebid__Affirmation_and_Disclosure_-_Done.pdf
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- Attached to
- Competitive Selection OH|DOT247A24-2
- Contract number
- DOT247A24-2
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is signed by a contractor located at 1085 S. 3rd Street in Manchester, IA 52057, and focuses on 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 and that no state data will be sent or accessed outside the country without a signed waiver.
The specific contract details are not fully elaborated in this document, which appears to be a compliance form for a potential contract involving truck-mounted spreaders. The form requires the contractor to disclose all locations where services will be performed and where state data will be located, with the current contractor indicating all such locations are at the Manchester, IA address. The document emphasizes the contractor's obligation to immediately notify the state of any changes in service locations and acknowledges that the state reserves the right to terminate the contract if services are performed outside the United States without a proper waiver.
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Other files
| File | Type | Posted |
|---|---|---|
| 247A-24_Bid_Document.pdf | ||
| Signature__93_.pdf | ||
| 247A-24_Truck_Mounted_Spreaders_-_Rebid_247A-24_Pricing_Page.xlsx | XLSX spreadsheet |
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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)
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
1085 S. 3rd Street Manchester, IA 52057
Name/Location(s) where state data will be located by subcontractor(s):
(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.
Signature: ___________________________________
Contractor
Print Name: _______________________________
Title: ___________________________________
Date: ___________________________________
Heather E. Marino
Contract Administrator
March 26, 2024
File details come from the government source that posted it. Updated .