Affirmation_and_Disclosure_Form.pdf
PDF 85 KB Posted
- Attached to
- Islamic Religious Services - DRC260090 - LORCI
- Solicitation number
- SRC0000034959
- Issued by
- Lorain County, Ohio
About this file
This is an Affirmation and Disclosure Form (Rev. 3/22) required by a state contracting agency for all contractors and subcontractors entering into agreements with the State. The form mandates contractor compliance with applicable Executive Orders prohibiting offshore service performance, locating State data offshore, and purchasing from Russian institutions or companies. Contractors must disclose the principal location of their business, all locations where services will be performed, and all locations where State data will be stored. The form requires identification of all subcontractors and their respective business locations and service performance locations. Contractors must affirm that they have read and understand the applicable restrictions and agree to immediately notify the State of any changes or shifts in service location before, during, or after contract execution.
The form incorporates a critical compliance obligation whereby contractors and subcontractors must maintain transparency regarding geographic performance of work and data storage throughout the contract lifecycle. The State retains the right to immediately terminate any contract if services are performed outside the United States without a duly signed waiver from the State. Failure to provide complete location information may result in no award. A duly authorized contractor representative must execute the form by signature, printed name, title, and date, certifying that the Affirmation and Disclosure Form becomes an incorporated component of any resulting contract with the State.
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Other files
| File | Type | Posted |
|---|---|---|
| EO_2022-02D__2.pdf | ||
| EO_2019-12D.pdf | ||
| Instructions for Bidding.pdf | ||
| Islamic services pricing.pdf | ||
| Islamic solicitation - LorCI.pdf |
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Text version
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:
File details come from the government source that posted it. Updated .