Affirmation_and_Disclosure (2).pdf
PDF 110 KB Posted
- Attached to
- Property Tracking and Land Management System State and local contract opportunity
- Solicitation number
- SRC0000035110
- Issued by
- Ohio
About this file
This is an Affirmation and Disclosure Form (Version 5/24) required by a state for contractor compliance with Executive Orders regarding offshore service prohibitions, state data security, and Russian institution sanctions.
The form requires contractors to disclose their principal business location, all service performance locations, and all locations where state data will be accessed, tested, maintained, backed up, or stored. Contractors must provide identical information for any subcontractors engaged under the contract. The form explicitly requires that all services be performed and all state data be located within the United States, with the state retaining the right to terminate the contract if services are performed or data is located outside U.S. borders unless a signed waiver from the state has been obtained. Contractors are obligated to disclose any changes or shifts in service locations before, during, and after contract execution and must notify the state immediately of such changes.
An authorized contractor representative must execute the form by signature, printed name, title, and date, certifying that they are duly authorized to bind the contractor and that they have read and understand the form's terms. The signatory acknowledges that the form is incorporated into any contract the contractor enters with the state and represents a binding commitment to comply with all stated requirements regarding location disclosure, data security, and notification obligations.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| ODNR OBF Property Tracking and Land Management System RFP final draft.pdf | ||
| Standard_T_C 3-1-24.pdf | ||
| Supplement_A_-_State_IT_Policy_Standard_and_Service_Requirements_20240710.pdf | ||
| Data_Security_and_Privacy_Terms_v1.1.pdf | ||
| Independent Contractor_Worker Acknowlegment.pdf | ||
| Requirements OBF Prop Track Land Mgmt System.pdf | ||
| Example Contract-Service Agreement- Non Federal Funds.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 .