New_Horizons_Affirm_Disclosure_RFP_009-25-signed.pdf
PDF 2 MB Posted
- Attached to
- Competitive Selection OH|DOT00925-17
- Contract number
- DOT00925-17
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is completed by a contractor located at 707 Landa Street in New Braunfels, Texas, and addresses compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The contractor affirms that no services will be performed outside of the United States without a signed waiver from the state, and confirms no subcontractors will be used for this contract.
The contract appears to involve virtual service delivery, with all state data to be located at the contractor's primary business address in New Braunfels, Texas. The document is signed by Gregory Pierce, Vice President of Legal & General Counsel, on 4/1/2024, and emphasizes the contractor's commitment to not perform any services in Russia and to immediately notify the state of any potential changes in service location. While specific service details are not elaborated, the form represents a compliance document ensuring the contractor's adherence to state procurement regulations and geographic service restrictions.
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Other files
| File | Type | Posted |
|---|---|---|
| 0009-25_Bid_Document.pdf | ||
| New_Horizons_OH_DOT_RFP_009-25Pricing.xlsx | XLSX spreadsheet | |
| Signature.pdf |
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Text version
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:
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
CarlyJoier Typewritten Text
CarlyJoier Typewritten Text 707 Landa Street
CarlyJoier Typewritten Text New Brunfels, TX 78130
CarlyJoier Typewritten Text No Subcontractors
CarlyJoier Typewritten Text N/A
CarlyJoier Typewritten Text Services delivered virtually - N/A
CarlyJoier Typewritten Text 707 Landa Street
CarlyJoier Typewritten Text New Braunfels, TX 78130
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)
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.
Signature: ___________________________________
Contractor
Print Name: _______________________________
Title: ___________________________________
Date: ___________________________________ 4/1/2024
CarlyJoier Typewritten Text N/A
CarlyJoier Typewritten Text Gregory Pierce
CarlyJoier Typewritten Text Vice President of Legal & General Counsel
File details come from the government source that posted it. Updated .