Affirmation___Disclosure__A_D__Form_WCI_wilmington.pdf
PDF 198 KB Posted
- Attached to
- Agency Administered OH|403-24-3277C
- Contract number
- 403-24-3277C
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form for a contract involving Wilmington College and the State of Ohio, specifically related to services to be performed at Warren Correctional Institution in Lebanon, Ohio. The form is designed to ensure compliance with Executive Orders regarding offshore services, data location, and purchasing restrictions, requiring the contractor to disclose locations where services will be performed and data will be stored.
The contract appears to be for a Prison Education Program, with Wilmington College serving as the primary contractor. The services will be performed at Warren Correctional Institution, located at 5787 W Lebanon, State Route 63 in Ohio. The contract is set to be executed by Ursula McTaggart, Area Coordinator of the Prison Education Program, with a documented date of 4/29/2025. No subcontractors are indicated, and all services and data will be maintained within the United States at Wilmington College's primary location in Wilmington, OH.
View the file
Other files
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):
Wilmington College, 1870 Quaker Way Wilmington, OH 45177
Not applicable
Lebanon, OH 45036Warren Correctional Institution, 5787 W
State Route 63
Not applicable
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:
Wilmington College, 1870 Quaker Way Wilmington, OH 45177
Not applicable
Ursula McTaggart
Area Coordinator, Prison Education Program
4/29/2025
File details come from the government source that posted it. Updated .