Affirmation_and_Disclosure_Form_019-25.pdf
PDF 103 KB Posted
- Attached to
- Competitive Selection OH|DOT01925-3
- Contract number
- DOT01925-3
- Issued by
- Ohio
About this file
The document is an Affirmation and Disclosure Form for Korman Signs Inc., a contractor based in Henrico, VA 23228, relating to a state contract with the Ohio Department of Transportation (ODOT). The form affirms compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions, and reinforces previous restrictions on offshore services. The contractor certifies that all services will be performed within the United States and that state data will be maintained exclusively within the company's Henrico, VA location.
The form does not specify the exact goods or services under contract, but requires the contractor to disclose and commit to performing all work within the United States. The contractor, represented by Sarah Korman Bodwell as President, signed the document on 8-15-24, agreeing to immediately notify the state of any potential changes in service locations and understanding that the state reserves the right to terminate the contract if services are proposed to be performed outside the United States. No specific contract value, pricing terms, or option periods are detailed in this disclosure document.
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Other files
| File | Type | Posted |
|---|---|---|
| 019-25_Bid_Document.pdf | ||
| ODOT_Co-Op_Program_Information.pdf | ||
| 019-25_pricing_2___1_.xlsx | XLSX 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 senrices 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 wll not be using subcontractors. Indicate ‘Not Applicable” in the appropriate spaces.
EXPENDITURE OF PUBUC 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 prohibHed from the purchase of services from Russian companies or institutions. This prohibition is in addition to and expands upon Executive Order 2019-12D vrfiich generally precludes the purchase of offshore sen/ices by the State of Ohio. Notwithstanding any other terms of this Contract. ODOT reserves the irght to recover any funds paid for senrices the Contractor performs in Russia in violation of this Executive Order. ODOT does not waive any other irghts and remedies provided to ODOT in this Contract
The Contractor agrees to complete the attached Exhibit li, 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 vrill be performed in Russia.
1. Prindpal location of business of Contractor
3029 Lincoln Avenue Henrico, VA 23228
(City. State. Zip)(Address)
Name/Prindpal location of business of subcontractor(s):
(Address. City. State, Zip)(Name)
(Name) (Address, City, State. Zip)
2. Location where services will be performed by Contractor:
Henrico, VA 232283029 Lincoln Avenue
(Address) (CKy.State.zip)
Name/Location where sen/lces 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
Henrico, VA 232283029 Lincoln Avenue
(Address) (City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
(Address. City, State, Zip)(Name)
(Address. City, State, Zip)(Name)
(Name) (Address, City, State. Zip)
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 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 by the Contractor 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.
(AN ORIGINAL SIGNATURE IS REQUIRED)
Company Name: Korman Signs Inc
Sarah ] Corman B^wwdl ^ Signature:.
Print Name:
Title: President
8-15-24Date:
File details come from the government source that posted it. Updated .