Affirmation and Disclosure Form_4-17-24.pdf
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- Solicitation number
- SRC0000036090
- Issued by
- Ashland County, Ohio
About this file
This is an Affirmation and Disclosure Form related to a bid solicitation issued by the Ohio Department of Natural Resources, Division of Parks and Watercraft, for kitchen drain line replacement work at Mohican State Park in Loudonville, Ohio. The project encompasses drain line replacement in 24 cabins, requiring removal and replacement of counters, cabinets, drywall, insulation, copper drain lines, and condensation lines with new 1-inch PVC piping. The scope of work includes testing drain lines for leaks, installing replacement piping and insulation, installing a new RFP panel board for access, reinstalling cabinets and counters with new caulking, and completing all debris removal and site cleanup. All materials, including RFP board and caulking colors, require approval by the park manager. The project completion deadline is February 28, 2026. Prior to submitting a bid response, offerors are required to visit the park cabins and coordinate with Park Manager Jenny Roar at 419-296-6528 or jennifer.roar@dnr.ohio.gov regarding site visit scheduling and onsite work timing.
The Affirmation and Disclosure Form serves as a certification document for bidders participating in this solicitation. The contractor is responsible for all demo, haul-away, site cleanup, and material costs. All work must be coordinated with the park manager regarding safety, foot and road traffic management, and general scheduling. The park manager will approve craftsmanship and project quality prior to payment authorization. The form likely contains representations and certifications required by the state regarding bidder qualifications, business status, and compliance with applicable regulations and requirements.
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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 .