Affirmation_and_Disclosure__2_.pdf
PDF 245 KB Posted
- Attached to
- Competitive Selection OH|DOT06226-17
- Contract number
- DOT06226-17
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form from Small's Inc., Ready Mix, located at 10229 Killduff Road in Gambier, Ohio 43022. The form is associated with the Ohio Department of Transportation (ODOT) and relates to Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The form affirms that the contractor will not perform any services outside the United States and will not allow state data to be accessed or stored outside the United States without a signed waiver.
The document indicates that all services and state data will be performed and located at the contractor's principal business address in Gambier, Ohio. No subcontractors are listed, and the company commits to complying with the executive order by ensuring no services will be performed in Russia. The form is signed by Mary C. Gerrad, President of Small's Inc., Ready Mix, on April 16, 2025, and requires an original signature to be considered valid. The contractor acknowledges the requirement to disclose any changes in service location or subcontractor arrangements immediately to the state.
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Other files
| File | Type | Posted |
|---|---|---|
| 062-26.pdf | ||
| 062-26_Pricing_Page__03_21_25__04_28_25_.xls | XLS spreadsheet | |
| Signature.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 2019-120 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;
10229 Killduff Road Gambier, Ohio 43022
(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:
10229 Killduff Road Gambier, Ohio 43022 (Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
10229 Killduff Road Gambier, Ohio 43022 (Address) (City, State, Zip)
File details come from the government source that posted it. Updated .