Affirmation and Disclosure Form_3-4-22.pdf
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- Solicitation number
- SRC0000022229
- Issued by
- Fairfield County, Ohio
About this file
This document is an Affirmation and Disclosure Form related to a state and local contract opportunity issued by the Ohio Department of Natural Resources (ODNR). The contract is for aquatic herbicide spraying services at various fishing and boating access areas in Northwest Ohio, to be performed during Fiscal Year 2025. The contractor will be responsible for twice-yearly spraying at eight designated locations, including ponds, shorelines, and access roads across four counties. Key requirements include the use of approved herbicides, compliance with regulations, coordination with private property owners, and provision of before and after treatment photos. The initial spraying is scheduled for late August 2024, and the second spraying for the 2nd or 3rd week of May 2025.
The contract will be awarded based on the contractor's proposed pricing, which must detail the types, brands, and amounts of materials to be used. The contracting documents do not specify any set-aside designations or restrictions on the types of organizations that can respond, nor do they indicate any incumbent vendors or current contractors, or any existing infrastructure or technology that requires integration. The Scope of Work details the locations and frequency of the required services, but the contracting documents do not include any listed award values or budget ranges for this state and local contract opportunity.
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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 .