Affirmation___Disclosure_Form.pdf
PDF 231 KB Posted
- Attached to
- Competitive Selection OH|DOT28125B-1
- Contract number
- DOT28125B-1
- Issued by
- Ohio
About this file
This document is an Exhibit 2 Affirmation and Disclosure Form related to a state contract, requiring the contractor to disclose locations of business operations and data storage. The primary contractor is located at 797 E. Market St. Suite 208 in Akron, Ohio 44305, with one identified subcontractor, Mac LTT Liquid Tank Trailers, located at 1400 Fairchild Ave. in Kent, Ohio 44240. The form affirms the contractor's understanding of Executive Orders prohibiting offshore services, offshore data storage, and purchasing from Russian institutions or companies.
The document indicates that all services will be performed in Ohio, specifically with an "Assigned Location" in the state. The contractor (Dan Smith, Lead Procurement Officer) commits to immediately notify the state of any changes in service location before, during, or after contract execution. The form includes provisions allowing the state to terminate the contract if services are moved outside the United States without a signed waiver. While specific contract details about goods or services are not elaborated in this disclosure form, the document serves as a compliance and transparency mechanism for the state contract, ensuring all business operations remain domestically situated.
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Other files
| File | Type | Posted |
|---|---|---|
| 281-25_Pricing_Page__1_.xlsx | XLSX spreadsheet | |
| ODOT_Co-Op_Program_Information.pdf | ||
| 281-25_Bid_Document__1_.pdf | ||
| Signature.pdf |
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Text version
EXHIBIT 2
AFFIRMATION AND DISCLOSURE FORM
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.
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.
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:
3. Name/Location where services will be performed by subcontractor(s):
4. Location where state data will be located, by Contractor:
DB Smith 797 E. Market St. Suite 208
DB Smith Akron, Ohio 44305
DB Smith Mac LTT Liquid Tank Trailers
DB Smith 1400 Fairchild Ave, Kent, Ohio, 44240
DB Smith 797 E. Market St. Suite 208
DB Smith Akron, Ohio 44305
DB Smith 1400 Farchild Ave
DB Smith Kent Ohio, 44240
DB Smith Assigned Location
Ohio
5. 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.
By: __________________________________
Contractor
Print Name: _________________________________
Title: __________________________________
Date: __________________________________
Dan Smith
DB Smith Lead Procurement Officer
DB Smith 09/12/2024
DB Smith Mac LTT Liquid Tank Trailers
1400 Fairchild Ave, Kent, Ohio, 44240
File details come from the government source that posted it. Updated .