ODOT_246-25__Affirmation_and_Disclosure_Document__Affirmation_and_Disclosure.docx
DOCX document 392 KB Posted
- Attached to
- Competitive Selection OH|DOT24625-1
- Contract number
- DOT24625-1
- Issued by
- Ohio
About this file
This document is an Affirmation and Disclosure Form from the Ohio Department of Transportation (ODOT), specifically addressing contract compliance requirements. The form focuses on restrictions related to service performance locations, with particular emphasis on prohibiting services from being performed in Russia, in alignment with Executive Order 2022-02D. The contractor identified is located at 2222 Akron-Peninsula Rd in Akron, Ohio.
The document mandates that no contract services can be performed outside the United States without a signed state waiver, and specifically prohibits state data from being sent, accessed, or stored internationally. Additionally, the form requires disclosure of service performance locations and subcontractor details, with potential contract award implications for non-compliance. A key provision prevents the purchase of services from Russian companies or institutions, allowing ODOT to recover funds if this requirement is violated. While specific contract details about goods or services are not fully elaborated in this document, it serves as a compliance and affirmation instrument for a state government contract.
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Other files
| File | Type | Posted |
|---|---|---|
| 246-25_Heavy_Lift_Pricing.xlsx | XLSX spreadsheet | |
| ODOT_Terms___Conditions.pdf | ||
| 246-25_Spec_2024-08-27.docx | DOCX document | |
| Signature__4___1___002___3_.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:
| 2222 AKRON-PENINSULA RD | AKRON, OH 44313 | |
| (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:
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