Affirmation_and_Disclosure_NN.pdf
PDF 198 KB Posted
- Attached to
- Competitive Selection OH|DOT57226-1
- Contract number
- DOT57226-1
- Issued by
- Ohio
About this file
This is an Affirmation and Disclosure Form from Nelson\Nygaard Consulting Associates, Inc., a consulting firm based in Chicago, Illinois. The document involves compliance with Ohio Department of Transportation (ODOT) contract requirements, specifically addressing Executive Order 2022-02D prohibiting services from Russian companies. The form lists several subcontractors including SRF Consulting Group (Saint Paul, MN), MurphyEpson Inc. (Columbus, OH), Access Planning (Vancouver, BC), and Sharp Point (Westerville, OH). The document requires disclosure of all locations where services will be performed and where state data will be located, with a clear mandate that no services can be performed outside the United States without a signed state waiver.
The contract appears to be a consulting services agreement where the primary contractor, Nelson\Nygaard Consulting Associates, Inc., and its subcontractors will provide professional services, likely related to transportation planning or consulting. The document emphasizes strict geographical restrictions on service delivery, mandating that all work must be performed within the United States and that state data cannot be accessed, stored, or maintained remotely outside the country. The signed form, executed by a Managing Director on 10/1/2025, serves as a binding affirmation of these terms, with the understanding that any change in service location must be immediately disclosed to the state, and the state retains the right to terminate the contract if these conditions are not met.
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Other files
| File | Type | Posted |
|---|---|---|
| Technical_Proposal_-_572-26_Transit_Development_Plans_-_NelsonNygaard_Submittal.pdf | ||
| 572-26.pdf | ||
| 572-26_Score_Sheet.xlsx | XLSX spreadsheet | |
| Cost_Proposal_-_572-26_Transit_Development_Plans_-_NelsonNygaard_Submittal.xlsx | XLSX spreadsheet | |
| Signature.pdf |
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Text version
AFFIRMATION AND DISCLOSURE FORM
By the signature affixed hereto, the Contractor affirms and understands that if awarded a contract, both the Contractor and any of its subcontractors shall perform no services requested under this Contract outside of the United States, not allow State data to be sent, taken, accessed, tested, maintained, backed-up, stored or made available remotely(located) outside of the United States unless a duly signed waiver from the State has been attained.
The 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.
EXPENDITURE OF PUBLIC FUNDS ON SERVICES PERFORMED BY RUSSIAN COMPANIES OR INSTITUTIONS.
The Contractor affirms to have read and understands Executive Order 2022-02D and shall abide by those requirements in the performance of this Contract. Pursuant to this Executive Order, all state agencies are prohibited from the purchase of services from Russian companies or institutions. This prohibition is in addition to and expands upon Executive Order 2019-12D which generally precludes the purchase of offshore services by the State of Ohio. Notwithstanding any other terms of this Contract, ODOT reserves the right to recover any funds paid for services the Contractor performs in Russia in violation of this Executive Order. ODOT does not waive any other rights and remedies provided to ODOT in this Contract.
The Contractor agrees to complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, to abide with Executive Order 2022-02D, which is incorporated and becomes a part of this Contract, affirming no services of the Contractor or its subcontractors under this Contract will be performed in Russia.
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):
3. Location where state data will be located, by Contractor:
410 N. Michigan Avenue, Suite 1600 Chicago, IL 60611
410 N. Michigan Avenue, Suite 1600 Chicago, IL 60611
1808 Swift Drive Oak Brook, IL 60523
SRF Consulting Group, Inc., Court International Building, 2550 University Avenue West, Suite 345N, Saint Paul, MN 55114
SRF Consulting Group, Inc., Court International Building, 2550 University Avenue West, Suite 345N, Saint Paul, MN 55114
Access Planning 1250 Homer Street, Suite 407, Vancouver, BC, V6B 1C6 Sharp Point 847 S Hempstead Road, Westerville OH 43081
MurphyEpson, Inc, 1650 Watermark Drive, Suite 210, Columbus, Ohio 43215
MurphyEpson, Inc, 1650 Watermark Drive, Suite 210, Columbus, Ohio 43215
Access Planning 1250 Homer Street, Suite 407, Vancouver, BC, V6B 1C6 Sharp Point 847 S Hempstead Road, Westerville OH 43081
Name/Location(s) where state data will be located by subcontractor(s):
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 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 by the Contractor 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.
(AN ORIGINAL SIGNATURE IS REQUIRED)
Company Name: _____________________________
Signature: __________________________________
Print Name: ________________________________
Title: ______________________________________
Date: ______________________________________
SRF Consulting Group, Inc., Court International Building, 2550 University Avenue West, Suite 345N, Saint Paul, MN 55114
Nelson\Nygaard Consulting Associates, Inc.
Jennifer Wieland
Managing Director
10/1/2025
MurphyEpson, Inc, 1650 Watermark Drive, Suite 210, Columbus, Ohio 43215
Access Planning (a part of Nelson\Nygaard Canada), 1808 Swift Drive, Oak Brook, IL 60523 Sharp Point 847 S Hempstead Road, Westerville OH 43081
File details come from the government source that posted it. Updated .