Affirmation_and_Disclosure_Form_5-20-24_fillable_form.pdfAffirmation_and_Disclosure_Form_5-20-24_fillable_form.pdf

This is an Affirmation and Disclosure Form for a State of Ohio microduct procurement (RFQ 2128, D22 designation). The request seeks two types of microduct products: 4,000 feet of 7-way 22/16mm microduct (Manufacturer Part Number DL-MT-FP-7W-22-16MM) and 10,000 feet of 4-way 14/10 microduct (Manufacturer Part Number DL-MT-FP-4W-14-10MM), both manufactured by FuturePath. The requested delivery date for both items is March 19, 2027.

The affirmation and disclosure form serves as a certification document that bidders must complete as part of their response to this procurement. This form type typically requires vendors to affirm compliance with applicable state regulations, disclose any relevant business relationships or conflicts of interest, and certify the accuracy of information provided in their bid submissions. Specific pricing terms, set-asides, incumbent information, and other financial details are not detailed in this form document itself, as affirmation forms function primarily as attestation instruments rather than detailed procurement specifications or financial summaries.