Affirmation_and_Disclosure_Form_5-20-24_fillable_form.pdf

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Attached to
ITRFQ0003637 Bluebeam Complete
Solicitation number
SRC0000036106
Issued by
Ohio

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Written by GovTribe AI ·

This is an Affirmation and Disclosure Form related to a state and local contract opportunity with the Ohio Department of Transportation for the purchase of Bluebeam Complete software. The form serves as a compliance document requiring contractors to affirm their understanding of Executive Orders prohibiting offshore services performance, locating state data offshore, and purchasing from Russian institutions or companies. Contractors must disclose the principal business location of their company, all subcontractor names and locations, specific locations where services will be performed, and all locations where state data will be accessed, tested, maintained, backed up, or stored. The form requires detailed information for both the primary contractor and any subcontractors involved in fulfilling the contract requirements.

The form establishes that contractors have a continuing duty to disclose any changes or shifts in service locations before, during, and after contract execution, with immediate notification required to the state. Contractors must affirm that all services will be performed within the United States, and the state reserves the right to terminate the contract if services are performed or state data is located outside the United States without prior written waiver. The authorized contractor representative must sign and date the form, certifying they are duly authorized to execute the document on behalf of the contractor. This affirmation and disclosure form is incorporated as a binding part of any contract executed with the state.

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Purchasing Standard Terms and Conditions - 05-2025.pdf PDF
Bluebeam Renewal Bid Specs 2026.docx DOCX document

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Version 5/24 Page 1 of 2

AFFIRMATION AND DISCLOSURE FORM

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.

The Contractor shall provide the name(s) and location(s) where all services under this Contract will be performed and where State data will be located in the spaces provided below or by attachment. If the Contractor will not be using subcontractors, indicate “Not Applicable” in the appropriate spaces.

Contractor Name: ___________________________ Contract Number:

1. Principal business location of Contractor:

(Address) (City, State, Zip)

Name(s)/Principal business location(s) of subcontractor(s):

(Name) (Address, City, State, Zip)

2. Location(s) where services will be performed by Contractor:

Name(s)/Location(s) where services will be performed by subcontractor(s):

Version 5/24 Page 2 of 2

3. Location(s) where any State data associated with any of the services Contractor is providing, or seeks to provide, will be accessed, tested, maintained, backed-up, or stored:

Name(s)/Location(s) where any State data associated with any of the services any subcontractor is providing, or seeks to provide, will be accessed, tested, maintained, backed-up, or stored:

Contractor also 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 to notify the State immediately of any such change or shift in location of its services. The State has the right to terminate the contract if any services are performed or State data is located outside of the United States unless a duly signed waiver from the State has been attained.

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: __________________________________ Authorized Contractor Signature

Print Name: ___________________________

Title: __________________________________

Date: __________________________________

Contractor Name:
Contract Number:
Address:
City State Zip:
Name:
Address City State Zip:
Name_2:
Address City State Zip_2:
Address_2:
City State Zip_2:
Address_3:
City State Zip_3:
Name_3:
Name_4:
Address City State Zip_3:
Address City State Zip_4:
Address_4:
City State Zip_4:
Address_5:
City State Zip_5:
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:
Print Name:
Title:
Date:

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