Affirmation___Disclosure__A_D__Form.pdf
PDF 85 KB Posted
- Attached to
- BeCI Protestant Chaplain
- Solicitation number
- SRC0000036656
- Issued by
- Belmont County, Ohio
About this file
This is an Affirmation and Disclosure Form (Rev. 3/22) required by the State of Ohio for contractors bidding on the Protestant Chaplain position at Belmont Correctional Institution. The form serves as a compliance document whereby contractors must affirm their understanding of Executive Orders prohibiting offshore services performance, offshore data location, and purchases from Russian institutions or companies. Contractors are required to disclose the principal location of their business, all locations where services will be performed, and all locations where state data will be stored, with separate sections for subcontractor information. The form emphasizes that contractors and their subcontractors have a continuing duty to disclose any changes or shifts in service location before, during, and after contract execution and must notify the State immediately of any such changes.
The form carries significant contractual consequences, as contractors must understand that the State reserves the right to immediately terminate the contract if services are performed or data is located outside the United States without a duly signed waiver from the State. Failure to provide the required location information may result in no award of the contract. The form must be signed by an authorized representative of the contractor and becomes an incorporated part of any resulting contract with the State. This disclosure requirement applies to all bidders regardless of contract value or scope and is a mandatory condition of participation in the solicitation process.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| EXECUTIVE_ORDER__2019-12D__1_.pdf | ||
| EXECUTIVE_ORDER__2022-02D.pdf | ||
| Terms___Condition.pdf | ||
| Contract_Chaplain__Protestant FY26.docx | DOCX document |
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 .