Affirmation and Disclosure Form - Rovisys.pdfAffirmation and Disclosure Form - Rovisys.pdf
PDF 91 KB Posted
- Solicitation number
- SRC0000042305
- Issued by
- Sandusky County, Cincinnati City, Ohio
About this file
This is an Affirmation and Disclosure Form submitted by RoviSys Corporation to the Ohio Department of Rehabilitation and Correction (ODRC) in response to a pest control services contract opportunity for Chillicothe Correctional Institution located at 15802 S.R. 104 North, Chillicothe, Ohio 45601. The form documents RoviSys's compliance with Executive Orders prohibiting offshore service performance, offshore data location, and purchasing from Russian institutions. RoviSys identified its principal business location at 1455 Danner Drive, Aurora, Ohio 44202, with no subcontractors listed for this engagement.
RoviSys designated two primary locations where services will be performed: 1455 Danner Drive in Aurora, Ohio 44202, and 4789 Rings Road in Dublin, Ohio 43017. The contractor identified four locations where state data will be located: 1455 Danner Drive in Aurora, Ohio 44202; 480 Green Oaks Parkway in Holly Springs, North Carolina 27540; 1200 Granger Road in Brooklyn Heights, Ohio 44131; and US-East Azure Cloud infrastructure. The form was executed by Oliver Tiber, Group Manager, on September 16, 2026. The contractor affirmed its understanding that any change in service location must be disclosed to the State immediately, with the State retaining the right to terminate the contract unless a signed waiver is obtained for performing services outside the United States.
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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):
Tiber, Oliver Typewriter RoviSys 1455 Danner Dr.
Tiber, Oliver Typewriter Aurora, Ohio, 44202
Tiber, Oliver Typewriter
1. 1455 Danner Dr.
2. 4789 Rings Rd.
Tiber, Oliver Typewriter
1. Aurora, Ohio, 44202
2. Dublin, Ohio, 43017
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:
Tiber, Oliver Typewriter
1. 1455 Danner Dr.
2. 480 Green Oaks Parkway
3. 1200 Granger Rd.
4. US-East Azure Cloud
Tiber, Oliver Typewriter
1. Aurora, Ohio, 44202
2. Holly Springs, NC, 27540
3. Brooklyn Heights, Ohio, 44131
4. N/A
Tiber, Oliver Typewriter Oliver Tiber
Group Manager
9/16/2026
| 2026-09-16T14:52:51-0400 | |
| Oliver Tiber |
File details come from the government source that posted it. Updated .