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

PDF 103 KB Posted Oct 23, 2026

Attached to: PWC Hocking Hills Winter Hike 2027 Busing
Solicitation number: SRC0000042643
Issued by: Hocking County, Ohio

About this file

Written by GovTribe AI · Oct 23, 2026

This is an Affirmation and Disclosure Form related to a passenger busing procurement by the Ohio Department of Natural Resources for Hocking Hills State Park's Annual Winter Hike scheduled for January 16, 2027. The service requires contractor provision of 12 buses with a seating capacity of 40 passengers each to shuttle hikers between various trail locations within the park. Bus service operations will commence at 8:00 am with 10 buses deployed initially and 2 additional buses at 9:30 am, continuing until completion but not exceeding 6:00 pm. The contractor must provide licensed drivers, communication radios for each bus, and fuel for all vehicles. Hocking Hills State Park will supply one radio for park employee communication and will coordinate bus release schedules based on hiker crowd levels at Ash Cave and driver communication.

The affirmation and disclosure form serves as a standard documentation requirement for bidder certification and compliance with state procurement regulations. Specific pricing terms, set-aside provisions, funding sources, and award dates are not detailed in this form document, as such information is typically contained within separate bid solicitation specifications and contract award notifications. Prospective bidders must complete this form as part of the submission package to certify their qualifications and compliance status for participation in the procurement process.

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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 Oct 23, 2026.