Affirmation_and_Disclosure_-_Signed__1_.pdf
PDF 116 KB Posted
- Attached to
- Competitive Selection OH|DOT02825-2
- Contract number
- DOT02825-2
- Issued by
- Ohio
About this file
This is an Affirmation and Disclosure Form for JCB, Inc., primarily involving the Ohio Department of Transportation (ODOT) and multiple subcontractors. The document affirms compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The primary contractor, JCB, Inc., is located in Pooler, GA, with subcontractors including Buck & Knobby, Burns JCB, Company Wrench, and American Equipment Services, all located in various Ohio locations. The form requires the contractor to confirm that all services will be performed within the United States and that no state data will be stored or accessed outside the country without a specific waiver.
The document does not provide specific details about the goods or services under contract, pricing terms, or contract amounts. However, it emphasizes strict compliance with state regulations regarding service locations and data management. The contractor (JCB, Inc.) and its subcontractors are required to immediately disclose any changes in service locations and understand that the state reserves the right to terminate the contract if services are moved outside the United States without proper authorization. The form is signed by Chris Masterson, Government Products and Sales Manager, with a date of 3/14/2025, indicating this is a forward-looking contractual agreement.
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Other files
| File | Type | Posted |
|---|---|---|
| 028-25_Four_Wheel_Drive_Backhoe_BID.pdf | ||
| Signature__4___1___002_.pdf | ||
| 028-25_Four_Wheel_Drive_Backhoe.xlsx | XLSX spreadsheet | |
| ODOT_Co-Op_Program_Information.pdf | ||
| ODOT_Terms___Conditions_with_excel_pricing.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:
2000 Bamford Blvd Pooler, GA, 31322 (Address) (City, State, Zip)
Name/Principal location of business of subcontractor(s):
Buck & Knobby 9127 Airport Highway, Holland, OH, 43528 Burns JCB 815 Roll and Hold Pkwy, Macedonia, OH, 44056 Company Wrench 4805 Scooby Ln; Carroll, OH, 43112 Company Wrench 920 Deneen Ave; Monroe, OH, 45050 American Equipment Services 3353 Gallimore Rd.; Sabina, OH, 45169 American Equipment Services 810 Shreve Rd.; Shreve, OH, 44676
2. Location where services will be performed by Contractor:
2000 Bamford Blvd Pooler, GA, 31322 (Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Same as above contractor info
3. Location where state data will be located, by Contractor:
Same as Above contractor info
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: JCB, Inc.
Signature: __________________________________
Print Name: Chris Masterson
Title: Government Products and Sales Manager
Date: 3/14/2025
File details come from the government source that posted it. Updated .