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 related to an Ohio state and local contract opportunity for the procurement of a navigation light assembly for the ERI-2 Sandusky Bay Bridge. The contract requires vendors to supply one Center Channel Navigation Light Assembly (Model # CC-B-JB-LED-G360, Part # NCCB-Y1G4-100-60-32) manufactured by B & B Roadway or an approved equivalent, along with one Scepter Green LED Lamp (Part # PLP-LED120BG/S). The light assembly must feature a cast bronze housing, mounting base, and junction box with a swivel assembly, automatic latch, stainless steel retrieval chain, 360-degree green 177 mm Fresnel lens, and a 1½-inch stainless steel pipe hanger stem with a 5-foot length. Vendors are required to submit shop drawings with their bids for departmental review, which requires one week for approval prior to contract award. Once approved, delivery must be completed within 12 weeks of contract award.

Vendors must complete the Affirmation and Disclosure Form as part of their bid submission. The form serves as a formal declaration of compliance with bidding requirements and disclosure of any relevant information pertaining to the vendor's qualifications and business standing. This disclosure process ensures transparency and allows the State of Ohio to verify vendor eligibility before contract award.