Affirmation_and_Disclosure_Form.pdf
PDF 85 KB Posted
- Attached to
- Catholic Religious Services - DRC260089 - LORCI
- Solicitation number
- SRC0000034956
- Issued by
- Lorain County, Ohio
About this file
This is an Affirmation and Disclosure Form (Rev. 3/22) required for state contract opportunities. The form mandates that contractors affirm their understanding of Executive Orders prohibiting offshore services performance, offshore state data location, and purchases 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 located. The form requires identical disclosures for any subcontractors used on the contract. Contractors must indicate "Not Applicable" if no subcontractors will be utilized. The form explicitly requires contractors to provide complete name and location information in the designated spaces or by attachment, with failure to provide this information potentially resulting in contract non-award.
Contractors and their subcontractors must maintain a duty to disclose any changes or shifts in service performance locations before, during, and after contract execution and notify the State immediately of such changes. The State reserves the right to immediately terminate the contract if services are performed outside the United States unless a duly signed waiver has been obtained from the State. A duly authorized representative of the contractor must execute the form, providing their signature, printed name, title, and date of execution. This affirmation and disclosure form is incorporated as part of any contract entered into with the State and is binding on all parties.
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Other files
| File | Type | Posted |
|---|---|---|
| Catholic services pricing.pdf | ||
| EO_2019-12D.pdf | ||
| Instructions for Bidding.pdf | ||
| EO_2022-02D__2.pdf | ||
| Catholic solocitation - 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 .