Affirmation and Disclosure Form_3-4-22 (11).pdf
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- Solicitation number
- SRC0000028596
- Issued by
- Montgomery County, Ohio
About this file
The Affirmation and Disclosure Form is a document from the State of Ohio requiring contractors to disclose the locations where services will be performed and where state data will be stored for a contract with the Ohio Department of Natural Resources (ODNR). The form specifically relates to a mowing and litter pickup services contract for Appalachian Hills and Wolf Creek Wildlife Areas, covering approximately 29 acres across Morgan, Noble, Muskingum, and Guernsey Counties from July 1, 2025, through June 30, 2027. Services will be performed Monday through Friday between 7:00 AM and 5:00 PM, including mowing (1-4 times per month), trimming, brush/tree clearing, and comprehensive litter/debris pickup across 8 main areas and 28 parking lots.
The contract will be awarded to the lowest responsive and responsible bidder, with bid evaluation calculated by multiplying unit costs by estimated usage. The solicitation incorporates specific preference provisions, including Buy American (5%), Buy Ohio (2%), and Veteran-Friendly Business (2%) preferences. Contractors must complete various compliance documents and be registered with the Secretary of State, with encouragement for participation from Minority Business Enterprise (MBE) and Encouraging Diversity, Growth and Equity (EDGE) certified vendors. The form emphasizes strict requirements regarding offshore services, locating state data offshore, and purchasing from Russian institutions, with potential contract termination for non-compliance. Payments will be made at quoted prices per occurrence, subject to fund availability through Ohio General Assembly appropriations, with invoices required within 30 calendar days.
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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)
2. Location where services will be performed by Contractor:
Name/Location where services will be performed by subcontractor(s):
Rev. 3/22 Page 2 of 2
3. Location where state data will be located, by Contractor:
Name/Location(s) where state data will be located by subcontractor(s):
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:
Contractor
Print Name:
Title:
Date:
File details come from the government source that posted it. Updated .