Affirmation and Disclosure Form_4-17-24.pdf
PDF 84 KB Posted
- Solicitation number
- SRC0000021429
- Issued by
- Putnam County, Ohio
About this file
The document is an Affirmation and Disclosure Form required for a state and local contract opportunity in the state of Ohio. The contract is for a Video Game Concessionaire at the East Harbor State Park Campground in Ottawa County. The selected supplier will place video/arcade machines in the campground store for visitors to use when the store is open. The document requires the contractor to disclose the locations where services will be performed and where state data will be stored, both by the contractor and any subcontractors. The contractor must also affirm that they understand and will comply with any relevant executive orders regarding offshore services or purchasing from Russian institutions.
The contract opportunity does not provide details on pricing terms, set asides, incumbent contractors, funding requirements, or award amounts. The document focuses solely on the location and disclosure requirements for the contractor and any subcontractors providing services under the contract.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Standard_T_C_04-10-23.pdf | ||
| East Harbor Game room Specifications pm edits (1).docx | DOCX document | |
| OhioBuys+Fact+Sheet+for+Bidders_Suppliers (1).pdf | ||
| Addendum to Bid Quote Base Template (Non-Federal Funds)_Rev. 2022 03 14.docx | DOCX document |
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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 .