AFFIRMATION AND DISCLOSURE FORM.pdf
PDF 83 KB Posted
- Attached to
- Islamic Chaplain - DRC260104 - CCI
- Solicitation number
- SRC0000036053
- Issued by
- Sandusky County, Cincinnati City, Ohio
About this file
This is an Affirmation and Disclosure Form for the Ohio Department of Rehabilitation and Correction (ODRC) related to an Islamic Chaplain contract position at the Chillicothe Correctional Institution located in Chillicothe, Ohio. The form requires contractors to affirm compliance with Executive Orders prohibiting offshore service performance, offshore data location, 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, including information for any subcontractors used. The form applies to the contract for an Islamic Contract Chaplain position serving the approximately 2,600 incarcerated persons at Chillicothe Correctional Institution.
Contractors and subcontractors are under a duty to immediately notify the State of any changes or shifts in service performance locations before, during, or after contract execution. The State retains the right to immediately terminate the contract if services are performed outside the United States unless the State provides a duly signed waiver authorizing offshore performance. The contractor's authorized representative must sign and date the form, confirming they are duly authorized to execute the affirmation and that the form is incorporated as part of any resulting contract with the State.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EXECUTIVE ORDER #2019-12D.pdf | ||
| ISLAMIC CONTRACT CHAPLAIN.docx | DOCX document | |
| SAMPLE ODRC CONTRACT.pdf | ||
| EXECUTIVE ORDER #2022-02D.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .