Affirmation and Disclosure Form 4-17-24 Fill In.pdf

PDF 91 KB Posted

Attached to
PWC SW E John Bryan John Deere Mower STS018473 State and local contract opportunity
Solicitation number
SRC0000029937
Issued by
Greene County, Ohio

About this file

Written by GovTribe AI ·

The document is an Affirmation and Disclosure Form intended for use in a state contract opportunity, requiring contractors to provide detailed location information for business operations, service performance, and data storage. The form mandates that contractors affirm their understanding of Executive Orders prohibiting offshore services, offshore data storage, and purchasing from Russian institutions or companies, with specific requirements to disclose the principal business location, service performance locations, and data storage sites for both the primary contractor and any potential subcontractors.

The form emphasizes ongoing transparency, requiring contractors to immediately notify the state of any changes in service locations before, during, and after contract execution, with the state retaining the right to terminate the contract if services are moved outside the United States without a signed waiver. Contractors must sign and acknowledge their understanding that this disclosure form is an integral part of any potential state contract, effectively creating a binding commitment to maintain domestic service and data management practices throughout the contract period.

View the file

Other files for this state and local contract opportunity

Other files attached to PWC SW E John Bryan John Deere Mower STS018473, newest first.
File Type Posted
RFQ PWC SW John Bryan John Deere Mower STS018473.pdf PDF
S-LG.2 Ohio Buys Viewing and Responding to Solicitations LG v2.0.pdf PDF
Standard_T_C 3-1-24.pdf PDF
Ohio Buys New Bidder.pdf PDF

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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:

Address:
City State Zip:
Name:
Address City State Zip:
Name_2:
Address City State Zip_2:
Address_2:
City State Zip_2:
Name_3:
Address City State Zip_3:
Name_4:
Address City State Zip_4:
Address_3:
City State Zip_3:
Name_5:
Name_6:
Name_7:
Name_8:
Name_9:
Address City State Zip_5:
Address City State Zip_6:
Address City State Zip_7:
Address City State Zip_8:
Address City State Zip_9:
Contractor:
Print Name:
Title:
Date:

File details come from the government source that posted it. Updated .