Affirmation and Disclosure Form_3-4-22 (2).pdf
PDF 84 KB Posted
- Attached to
- Landscaping improvement project for the Magee Marsh Visitor Center State and local contract opportunity
- Solicitation number
- SRC0000032485
- Issued by
- Putnam County, Ohio
About this file
The document is an Affirmation and Disclosure Form, which requires contractors to provide detailed information about their business locations and service performance sites while affirming compliance with specific Executive Orders. The form mandates that contractors disclose the principal location of their business, the locations where services will be performed, and where state data will be stored, including information about any subcontractors involved in the contract.
The form emphasizes strict requirements regarding offshore services, prohibiting the performance of services, storage of state data, or purchasing from Russian institutions or companies outside the United States. Contractors are obligated to immediately notify the state of any changes in service locations before, during, or after contract execution, with the understanding that the state retains the right to terminate the contract unless a formal waiver is obtained. The document serves as a critical compliance mechanism for state contracts, ensuring transparency and adherence to geopolitical and data security restrictions.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 2025 MAGEE MARSH PLANT AND SEED LIST.pdf | ||
| OPERS Independent Contractor Form_fillable PDF Form (12).pdf | ||
| Scope of Services_Magee Marsh Visitor Center Gravel Walk and Pollinator Gardens.pdf | ||
| 2025 MMVC DESIGN PLANS.pdf | ||
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys (3).docx | DOCX document | |
| Standard Terms and Conditions (12).pdf |
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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 .