E_Standard Affirmation & Disclosure Form_fillable PDF Form.pdf
PDF 267 KB Posted
- Solicitation number
- SRC0000032297
- Issued by
- Stark County, Ohio
About this file
This document is an Affirmation and Disclosure Form related to a state contract opportunity that requires contractors to affirm and disclose specific details about their business operations. The form mandates that contractors and their subcontractors perform all contracted services within the United States and prohibit state data from being sent, accessed, or stored outside the United States without a signed waiver from the state. Contractors must provide detailed information about their principal business location, service performance locations, and data storage locations for both their own organization and any subcontractors.
The form emphasizes strict compliance with geographic service and data storage restrictions, with significant consequences for non-compliance. Contractors are obligated to immediately disclose any changes in service or data location before, during, and after contract execution, and the state retains the right to terminate the contract if these requirements are not met. The document serves as a legally binding disclosure that becomes an integral part of any potential contract, requiring authorized representation from the contractor who must sign and acknowledge understanding of these critical location and data management requirements.
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
Version 2/20 Page 1 of 2
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, nor 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
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:
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Version 2/20 Page 2 of 2
3. Location where state data will be located, by Contractor:
(Address) (Address, City, State, Zip)
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: __________________________________
| Address: |
| City State Zip: |
| Name: |
| Address City State Zip: |
| Name_2: |
| Address City State Zip_2: |
| Address_2: |
| City State Zip_2: |
| Name_3: |
| Name_4: |
| Address City State Zip_3: |
| Address City State Zip_4: |
| Address_3: |
| Address City State Zip_5: |
| Name_5: |
| Name_6: |
| Name_7: |
| Name_8: |
| Name_9: |
| Address City State Zip_6: |
| Address City State Zip_7: |
| Address City State Zip_8: |
| Address City State Zip_9: |
| Address City State Zip_10: |
File details come from the government source that posted it. Updated .