Affirmation_Disclosure_Form_LION_SRC0000023890.pdf
PDF 207 KB Posted
- Attached to
- Agency Administered OH|CTR024940
- Contract number
- CTR024940
- Issued by
- Ohio
About this file
This document is an Exhibit 2 Affirmation and Disclosure Form, which confirms a contractor's compliance with Executive Orders regarding offshore services, data location, and purchasing restrictions. The contractor is located at 7200 Poe Avenue in Dayton, Ohio 45414, with a service performance location at 66 Janney Road in Dayton, Ohio 45404. The form is signed by Melissa Kirk, a Distribution Sales Manager, on 10/9/24, and indicates no subcontractors will be used for this contract.
The form primarily serves to disclose the contractor's business locations and data storage sites, affirming that all services and data will be maintained within the United States. The contractor agrees to immediately notify the state of any potential changes in service location and understands that failure to maintain domestic operations could result in contract termination. While specific contract details are not provided in this document, the form represents a critical compliance document ensuring the contractor's adherence to state regulations regarding service delivery and data management.
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Other files
| File | Type | Posted |
|---|---|---|
| Lion_Group_Inc._COM_Contract_FY25-Complete.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)
(Name) (Address, City, State, Zip)
2. Location where services will be performed by Contractor:
(Address) (City, State, Zip)
3. Name/Location where services will be performed by subcontractor(s):
(Address) (City, State, Zip)
(Address) (City, State, Zip)
4. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
(Address) (City, State, Zip)
7200 Poe Avenue Dayton, Ohio 45414
N/A
66 Janney Road Dayton, Ohio 45404
N/A
7200 Poe Avenue Dayton, Ohio 45414
5. Name/Location(s) where state data will be located by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
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:
Print Name:
Title:
Date:
Contractor
N/A
Melissa Kirk
Distribution Sales Manager
10/9/24
File details come from the government source that posted it. Updated .