_578-26_Marketing_Support__Affirmation_and_Disclosure.pdf
PDF 182 KB Posted
- Attached to
- Competitive Selection OH|DOT57826-1
- Contract number
- DOT57826-1
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form for a contract involving MurphyEpsen, Inc. as the primary contractor, with two subcontractors: Apps by John, LLC and Sharp-Point. The form is associated with the Ohio Department of Transportation (ODOT) and specifically addresses compliance with Executive Order 2022-02D regarding the prohibition of purchasing services from Russian companies or institutions. The document requires disclosure of business locations, service performance locations, and data storage locations for the contractor and its subcontractors.
The form emphasizes that no services will be performed outside of the United States, and state data cannot be sent, accessed, or stored remotely outside the United States without a signed waiver. The contractor (MurphyEpsen, Inc.) has specified its principal business location as 1650 Watermark Drive, Suite 210 in Columbus, Ohio, with subcontractors located in Galena and Westerville, Ohio. The document is signed by Marie S. Keister, President/CFO, with an execution date of October 1, 2025, affirming compliance with the state's requirements regarding service performance and data handling.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Signature.pdf | ||
| 578-26.pdf | ||
| 578-26_Score_Sheet.xlsx | XLSX spreadsheet | |
| _578-26_Pricing_Document__578Pricing__1_.xlsx | XLSX spreadsheet | |
| 251002_ME_ODOT_Transit_Technical_Proposal_2.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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):
(Address, City, State, Zip)
(Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
1650 Watermark Drive, Suite 210 Columbus, Oh 43215
Apps by John, LLC
Sharp-Point
1750 Africa Road, Galena, OH 43021
1750 Africa Road, Galena, OH 43021
1650 Watermark Drive, Suite 210 Columbus, Oh 43215
Columbus, Oh 432151650 Watermark Drive, Suite 210
Apps by John, LLC
(Name)
(Name)
847 S. Hempstead Road, Westerville, OH 43081
847 S. Hempstead Road, Westerville, OH 43081Sharp-Point
847 S. Hempstead Road, Westerville, OH 43081Sharp-Point
File details come from the government source that posted it. Updated .