IMG_20250903_0002.pdf

AFFIRMATION AND DISCLOSURE FORM

By the signature affixed hereto, the Contractor afFjrms and understands that if awarded a contract. both the Contraclor and any of its subcootractors shaii peiforrri no services requested under thjs Coniiaci cutside of lhe Uni ied States. not allow Stale data to be sent, taken, accessed, tested, maintained, backed-up, stored or made available ren rolely(located) outside oI lhe UniGd States unless a dulv 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. Failui'e to provide this information may resull in no award. lfthe Contractor will not be using subcontractors, indicate "Not Applicable" in the appropriate spaces.

EXPENDITURE OF PUBLIC FUNDS ON SERVICES PERFORMED BY RUSSIAN COMPANIE$ OR INISTITTJTIONS, The Contractor affirms to have read and understands Executive O.det 2O22-O2D and shall abide by those requirements in the performance of this Contract. Pursuant to this Executive Order, all stale agencies are prohibited ftom the purchase of services fiom Russian companies or institutions. This prohibitbn is in addition to and expands upon Executive Order 2019-12D which generally precludes the purchase of of{shore services by the State of Ohio. Notwithstanding any olher ierms ofthis Contract, ODOT reserves the right to recover any funds paid for services the Contractor performs in Russia in violation o, this Executive Order. ODOT does not waive any olher rights and remedies provided to ODOT in this Contract.

The Contractor agrees lo complete the atached Exhibit ll, Contractor/Subcontractor Affirmation and Disclosure Form, lo abide with Executive o{det 2022-O2D, which is incorporated and becornes a part of lhis Contract, afnming no services ofthe Contractor or its subcontractors under this Contract will be performed in Russia.

1. Principal location ol business of Contractor:

(Address)

Name/Principal location of business oi subcontractor(s):

nln (Name) (Address, City, State, Zip)

(Name) (Address, City, Siate, zip)

Oluo (City, State, Zip)

Name/Location where services will be performed by subcontracto.(s):

(Address, City, State, Zip)

(Name)

3. Location wher6 state data will be located, by Contractor:

(Address, City, State, zip)

(Address) n/nm

2, Location where services will be performed by Contracior:

Name/Location(s) where state data will be located by subcontractor(s):

4/e (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 subcontracto.s are under a duty to disclose to the State any change or shift in location of seNices performed by Contractor or its subcontractors befo re, during and after execution ol any contract with the State. Contractor agrees il shall so notify the State immediatel y 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 waiverfrom the Stale has been attained by tle Contractor to peform the services outside the Un ited States.

On behalf of the Contractor, I acknowledge that I am duly authorized to execute this Affirmation and Dis closure Fo.m and have read and understand that this lorm is a part of any Contract that Contraclor may enter into with the State and is incorporated therein.

(AN ORIGINAL SIGNATURE IS REAUIRED}

*^r".^" r, il Nurnon,E"lrTc. G-a Signature:

Print Namel

,r0", CeO Date:

Section 4:

Section 5:

Section 6:

Section 7:

Bid Pricing for Service Locations

The net unit bid prices shall be as designated on the Pricing Sheet. See Section 5, Hours of Wcrk, for establishing bid prices.

NOTE: Purchase orders, when issued, will detail specific destination points.

NOTE: The vendor will be required to provide services in all counties within each DisL rict they bid.

Hours of Work

Operating times for the purpose of this contract bid shall be based upon an eight (8) hour day, and a five

(5) day (40 hour) week.

ODOT and the vendor may agree to alternate schedules per project. Pricing will be adjusted accordingly.

vendor Review of Proposed Work

District will contact vendor(s) to revicJlv proposed Proiect and request a quote. Upon review ol quotes, ODOT will consider the quotes and received in determining ot the pOect will be performed, and in selecting a vendor.

Vendor will be required to begin services within five (5) calendar days after written or verbal notification of a purchase order to perform work from the Department.

Specifications, Terms & Gonditions for Tree & Brush Power Shearing, Trimming, ltlulching, and Removal

Environmental Requirements

Mulched or chipped debris can be left in place as long as it does not creale a hazard ol biock drainage as determined by ODOT.

ftic to peftmirg tle wglq it lhe uo* ha gwiornernd resddory r€sidims, lhe Distii :

Environrnental Minator, Transportation Adminisffir or Disffi,lcounty designee yrill provide a fist of ' conditions for each site that the vendor rnust Idlow. ODOT will oblain all necerisary enviroflmenta:

dearances and provide the conditions to the Vendor prior to the qucte tequest for a sp€cilic praj€ct- Condilions may inchide, but Bre not timited tr seasc*al Hork restrictions, avoiding i, npacts to pmtected resourcEs suct! as sbeams, wedands, or culfural rescurces- The Vendoa will ltaform ali wcrk in adlEaence to ttEse siE-specific Equi€fiEnts, cooditixls" and linihlbns-

7.1

District 'l'l - New Philadelphia

Rev. 0512712O25 2