Affirmation and Disclosure Form_3-4-22.pdf
PDF 84 KB Posted
- Attached to
- Passenger Bus Service (10 Busses x 40 passengers each) on January 18, 2025 - Hocking Hills State Park
- Solicitation number
- SRC0000023686
- Issued by
- Hocking County, Ohio
About this file
This document is an Affirmation and Disclosure Form required by the State for any contractor performing services or handling state data. It requires the contractor to affirm that they have read and understand the applicable Executive Orders regarding prohibitions on offshore services and Russian institutions, and to disclose the locations where services will be performed and state data will be located, by both the contractor and any subcontractors. The contractor must also affirm their understanding that they are under a duty to disclose any changes in the location of services before, during, and after the contract, and that the State has the right to terminate the contract if services are performed outside the United States without a waiver.
The document does not provide details on a specific contract opportunity, but rather outlines the general requirements and disclosures expected of any contractor doing business with the State. It does not include information on product/service specifications, quantities, response dates, award details, contract term, or pricing.
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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 .