Affirmation_and_Disclosure_-_Signed.pdf
PDF 268 KB Posted
- Attached to
- Competitive Selection OH|DOT37525-5
- Contract number
- DOT37525-5
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form for Red River Specialties, LLC d.b.a Azelis A&ES, a company located in Shreveport, Louisiana, in connection with a state contract. The form is specifically related to compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The document is associated with the Ohio Department of Transportation (ODOT) and requires the contractor to affirm that no services will be performed in Russia and that all state data will be maintained within the United States.
The contractor indicates that services will be delivered to various locations, with the primary business and data storage located at 1324 North Hearne Ave. Ste. 120 in Shreveport, Louisiana. No subcontractors are listed, and the form is signed by Chad Chambliss in the capacity of Bid Manager on 8/5/2024. The document emphasizes the contractor's commitment to not sending, accessing, or storing state data outside the United States without a specific waiver, and affirms compliance with state regulations regarding offshore service procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| 375-25__Pricing__rev_1___gpr_8-5.2-24_Final.xlsx | XLSX spreadsheet | |
| 375-25_Bid_Document.pdf | ||
| ODOT_Terms___Conditions.pdf | ||
| ODOT_Co-Op_Program_Information.pdf | ||
| Signature__67_.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 11, 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:
1324 North Hearne Ave. Ste., 120 Shreveport, LA 71107 (Address) (City, State, Zip)
Name/Principal location of business of subcontractor(s):
Not Applicable (Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
Deliveries To Various Locations (Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Not Applicable (Name)
(Name)
3. Location where state data will be located, by Contractor:
1324 North Hearne Ave. Ste., 120 (Address)
(Address, City, State, Zip)
(Address, City, State, Zip)
Shreveport, LA 71107 (City, State, Zip)
File details come from the government source that posted it. Updated .