Affirmation and Disclosure Form_4-17-24.pdf
PDF 84 KB Posted
- Attached to
- Deer Creek Adventure Play Trail
- Solicitation number
- SRC0000033268
- Issued by
- Fairfield County, Ohio
About this file
This document is an Affirmation and Disclosure Form related to state contract requirements, specifically addressing offshore services and data location restrictions. The form requires contractors to provide detailed information about their principal business location, service performance locations, and the locations where state data will be stored. Contractors must disclose all locations for both their own services and any subcontractors' services, with a clear warning that failure to provide this information may result in no contract award.
The form emphasizes strict compliance with Executive Orders prohibiting offshore services, offshore data storage, and purchasing from Russian institutions or companies. Contractors are obligated to immediately notify the state of any changes in service or data locations before, during, or after contract execution. The state retains the right to immediately terminate the contract unless a formal waiver is obtained to perform services outside the United States. The document requires an authorized contractor representative to sign, acknowledging understanding of these terms and recognizing the form as an integral part of any potential state contract.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Services Agreement (Non-Federal Funds) Base Template_Rev. 2023 04 11.docx | DOCX document | |
| DAS Standard_T_C_3-31-25.pdf | ||
| DNR250010 Playground Structure RFP (1).pdf | ||
| Project Renderings for Bid.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .