Affirmation.pdf
PDF 329 KB Posted
- Attached to
- Competitive Selection OH|DOT050C24-1
- Contract number
- DOT050C24-1
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form (Invitation No. 050C-24) from a contractor located in Fort Lauderdale, Florida, submitted to the Ohio Department of Transportation (ODOT). The form specifically addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The primary contractor is based at 5250 NW 33rd Avenue in Fort Lauderdale, with Textron Lycoming (a manufacturer located at 652 Oliver Street in Williamsport, PA) listed as a subcontractor.
The form requires the contractor to affirm that all services and data management will be performed exclusively within the United States, with no offshore or remote data storage outside the country. The contractor agrees to immediately disclose any changes in service locations and understands that ODOT reserves the right to terminate the contract if services are moved outside the United States without a signed waiver. The document was signed by Rebekah Wright, Government Sales Manager, on 02/09/2024, and serves as a critical compliance document ensuring that state funds are not used for services connected to Russian entities or performed outside the United States.
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Other files
| File | Type | Posted |
|---|---|---|
| 050CPricing-SCA_bid_Q1372111.xlsx | XLSX spreadsheet | |
| Signature.pdf | ||
| 050C-24.pdf |
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Text version
Invitation No. 050C-24
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 II, 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:
(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:
Name/Location where services will be performed by subcontractor(s):
(Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
Name/Location(s) where state data will be located by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip) becka.pratt Typewritten text 5250 NW 33rd Avenue becka.pratt Typewritten text 5250 NW 33rd Avenue becka.pratt Typewritten text 5250 NW 33rd Avenue becka.pratt Typewritten text Fort Lauderdale, FL 33309 becka.pratt Typewritten text Fort Lauderdale, FL 33309 becka.pratt Typewritten text Fort Lauderdale, FL 33309 becka.pratt Typewritten text Textron Lycoming (Manufacturer) becka.pratt Typewritten text Textron Lycoming (Manufacturer) becka.pratt Typewritten text Textron Lycoming (Manufacturer) becka.pratt Typewritten text
652 OLIVER STREET, WILLIAMSPORT, PA 17701
becka.pratt Typewritten text
652 OLIVER STREET, WILLIAMSPORT, PA 17701
becka.pratt Typewritten text
652 OLIVER STREET, WILLIAMSPORT, PA 17701
Invitation No. 050C-24
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: ___________________________________
(the remainder of this page has been left intentionally blank) becka.pratt
Rebekah Wright becka.pratt Typewritten text Govt Sales Manager becka.pratt
02/09/2024
File details come from the government source that posted it. Updated .