_265-25_Jetting_and_Vacuum_Truck__Affirmation_and_Disclosure.pdf
PDF 368 KB Posted
- Attached to
- Competitive Selection OH|DOT26525-4
- Contract number
- DOT26525-4
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form for The Safety Company LLC dba MTech Company, submitted to the State of Ohio, specifically involving the Ohio Department of Transportation (ODOT). The form includes details about the contractor and its subcontractor, Super Products LLC, and affirms compliance with Executive Order 2022-02D regarding the prohibition of purchasing services from Russian companies or institutions. The primary contractor is located at 5642 Transportation Blvd. in Garfield Heights, OH, with the subcontractor based in Mukwonago, WI.
The document does not specify the exact goods or services under contract, but it outlines strict requirements for service performance and data management. The contractor affirms that all services will be performed within the United States and that state data will not be sent, accessed, or stored outside the country without a signed waiver. The form requires the contractor to disclose any changes in service locations before, during, and after contract execution, with ODOT retaining the right to immediately terminate the contract if these conditions are not met. The document was signed by Evan Tierney, VP of Operations and Technology, on 10/28/24, indicating the contract's future-dated status.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 265-25_Jetting__Vacuum_Truck__002__Bid.docx | DOCX document | |
| _Pricing_Document__265-25_Jetting___Vacuum_Truck.xlsx | XLSX spreadsheet | |
| ODOT_Co-Op_Program_Information.pdf | ||
| 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:
5642 Transportation Blvd. Garfield Heights, OH 44125 (Address) (City, State, Zip)
Name/Principal location of business of subcontractor(s):
Super Products LLC 130 W. Boxhorn Dr. Mukwonago, WI 43149 (Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
5642 Transportation Blvd. Garfield Heights, OH 44125 (Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Super Products LLC 130 W. Boxhorn Dr. Mukwonago, WI 43149 (Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
5642 Transportation Blvd. Garfield Heights, OH 44125 (Address) (City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
Super Products LLC 130 W. Boxhorn Dr. Mukwonago, WI 43149 (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.
(AN ORIGINAL SIGNATURE IS REQUIRED)
Company Name: The Safety Company LLC dba MTech Company
Signature: __________________________________
Print Name: Evan Tierney
Title: VP of Operations and Technology
Date: 10/28/24
File details come from the government source that posted it. Updated .