STANDARD AFFIRMATION AND DISCLOSURE FORM (EO 2019-12D & 2022-02D).pdf
PDF 124 KB Posted
- Attached to
- SODC Commercial Electric Double Convection Oven
- Solicitation number
- SRC0000027479
- Issued by
- Clermont County, Ohio
About this file
This is a Standard Affirmation and Disclosure Form governed by Executive Orders 2019-12D and 2022-02D for state contracts in Ohio, which addresses prohibitions on offshore services and responses to Russia's war. The form requires contractors to disclose all locations where services will be performed and where state data will be stored, both for the primary contractor and any subcontractors. The form requires three main disclosures: the principal location of business, locations where services will be performed, and locations where state data will be stored.
The form mandates immediate disclosure of any changes in service locations before, during, or after contract execution, with the state retaining the right to immediately terminate contracts if services are moved outside the United States without a state-approved waiver. The contractor must affirm they understand the prohibitions regarding offshore services, data storage, and purchasing from Russian institutions or companies. The form must be signed by an authorized representative of the contractor and becomes incorporated into any contract with the state department.
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| File | Type | Posted |
|---|---|---|
| SODC-Electric Double Convection Oven.pdf | ||
| Contractor Information Form (rev. 5.24).pdf |
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Text version
STANDARD AFFIRMATION AND DISCLOSURE FORM
EXECUTIVE ORDERS 2019-12D & 2022-02D
EO2019-12D & 2022-02D Form (rev. 3 2022)
Governing the Expenditure of Public Funds on Offshore Services & Response to Russia’s Unjust War
Contractor affirms that Contractor has read and understands the applicable Executive Orders regarding the prohibitions of performance of offshore services, locating State data offshore in any way, or purchasing from Russian institutions or companies.
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.
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(s) where services will be performed by Contractor:
Name/Location where services will be performed by subcontractor(s):
3. Location where state data will be located, by Contractor:
Name/Location(s) where state data will be located by subcontractor(s):
STANDARD AFFIRMATION AND DISCLOSURE FORM
EXECUTIVE ORDERS 2019-12D & 2022-02D
EO2019-12D & 2022-02D Form (rev. 3 2022)
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 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 of 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 Department and is incorporated therein.
By: ____________________________________
Print Name: _____________________________
Title: ___________________________________
Date: ___________________________________
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