Affirmation_and_Disclosure (2).pdf
PDF 110 KB Posted
- Attached to
- DOGRM Salt Fork Partitions
- Solicitation number
- SRC0000033867
- Issued by
- Greene County, Ohio
About this file
This document is an Affirmation and Disclosure Form designed to ensure compliance with Executive Orders regarding offshore services and international business restrictions. The form requires contractors to disclose detailed location information about their business operations, including the principal business location, locations where services will be performed, and specific sites where state data will be accessed, tested, maintained, backed-up, or stored. Contractors must explicitly identify their own locations as well as those of any potential subcontractors.
The form emphasizes strict requirements that all services and data handling must occur within the United States, with the state retaining the right to terminate the contract if services are performed or data is located outside the country. Contractors are obligated to immediately disclose any changes in service locations before, during, and after contract execution. The document requires an authorized contractor representative to sign, acknowledging understanding of these terms and affirming that the disclosure is part of the contract. A waiver from the state may be possible for exceptions to the United States-based service requirement, but such waivers must be formally signed and obtained.
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Other files
| File | Type | Posted |
|---|---|---|
| Standard_T_C 3-1-24.pdf | ||
| Example Contract-Service Agreement- Non Federal Funds.pdf | ||
| Salt Fork Office Solicitation.pdf |
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Text version
Version 5/24 Page 1 of 2
AFFIRMATION AND DISCLOSURE FORM
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.
The Contractor shall provide the name(s) and location(s) where all services under this Contract will be performed and where State data will be located in the spaces provided below or by attachment. If the Contractor will not be using subcontractors, indicate “Not Applicable” in the appropriate spaces.
Contractor Name: ___________________________ Contract Number:
1. Principal business location of Contractor:
(Address) (City, State, Zip)
Name(s)/Principal business location(s) of subcontractor(s):
(Name) (Address, City, State, Zip)
2. Location(s) where services will be performed by Contractor:
Name(s)/Location(s) where services will be performed by subcontractor(s):
Version 5/24 Page 2 of 2
3. Location(s) where any State data associated with any of the services Contractor is providing, or seeks to provide, will be accessed, tested, maintained, backed-up, or stored:
Name(s)/Location(s) where any State data associated with any of the services any subcontractor is providing, or seeks to provide, will be accessed, tested, maintained, backed-up, or stored:
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 to notify the State immediately of any such change or shift in location of its services. The State has the right to terminate the contract if any services are performed or State data is located outside of the United States unless a duly signed waiver from the State has been attained.
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: __________________________________ Authorized Contractor Signature
Print Name: ___________________________
Title: __________________________________
Date: __________________________________
File details come from the government source that posted it. Updated .