A_D_Decision_Points_2025.pdf
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- Attached to
- Agency Administered OH|CTR032124
- Contract number
- CTR032124
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form, revision 3/22, completed by Decision Points, with a principal business location at 6710 Laurel Bowie Road #529 in Bowie, Maryland. The form involves two subcontractors: JoAnne Haskett from Encinitas, California, and Norvetta Robinson from Bowie, Maryland. The contractor has affirmed understanding of Executive Orders regarding prohibitions on offshore services, state data location, and purchasing from Russian institutions.
The form specifies that services will be performed at OHDRC 4545 Fisher Road Suite D in Columbus, Ohio, with state data to be located at the contractor's Bowie, Maryland address. The subcontractors will also potentially handle services and data at their respective locations in California and Maryland. The document is signed by Charles Robinson, a Decision Points Partner, with an execution date of 05/08/2025. The form emphasizes the contractor's obligation to disclose any changes in service or data location to the state, with potential contract termination if services are performed outside the United States without a signed waiver.
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Text version
AFFIRMATION AND DISCLOSURE FORM
Rev. 3/22 Page 1 of 2
Contractor affirms that Contractor has read and understands the applicable Executive Orders regarding the prohibitions of performance of offshore services, locating State data offshore in any way, or purchasing from Russian institutions or companies.
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.
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)
(Name) (Address, City, State, Zip)
6710 Laurel Bowie Road #529 Bowie, MD 20718
JoAnne Haskett
Norvetta Robinson
1168 Monterrey Place Encinitas, CA 92024
7308 Quetzal Dr. Bowie, MD 20720
OHDRC 4545 Fisher Road Suite D Columbus, OH 43228
JoAnne Haskett 168 Monterrey Place Encinitas, CA 92024
Norvetta Robinson 7308 Quetzal Dr Bowie, MD 20720
Rev. 3/22 Page 2 of 2
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
Contractor 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 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: Charles Robinson Contractor
Print Name: Charles Robinson
Title: Decision Points Partner
Date: 05/08/2025
6710 Laurel Bowie Road #529 Bowie, MD 20718
JoAnne Haskett 1168 Monterrey Place Encinitas, CA 92024
Norvetta Robinson 7308 Quetzal Dr Bowie, MD 20720
File details come from the government source that posted it. Updated .