STANDARD_AFFIRMATION_AND_DISCLOSURE_FORM__EO_2019-12D___2022-02D_v1__1_.pdf
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- Attached to
- Agency Administered OH|CTR032298
- Contract number
- CTR032298
- Issued by
- Ohio
About this file
This document is a Standard Affirmation and Disclosure Form for Executive Orders 2019-12D & 2022-02D, pertaining to the expenditure of public funds on offshore services and response to Russia's actions. The form is completed by Aegis Training, located at 9477 Silverside Dr in South Lyon, Michigan, and appears to be part of a contractual obligation with a state government agency. The form requires disclosure of business locations, service performance sites, and data storage locations, with the contractor affirming compliance with specific executive orders regarding offshore services and restrictions on doing business with Russian institutions.
The contractor, Aegis Training, indicates that services will be performed in Columbus, Ohio, with no subcontractors listed. The company's principal business location and state data storage location are both at the South Lyon, Michigan address. The document emphasizes the contractor's commitment to not perform offshore services, not locate state data offshore, and not purchase from Russian institutions. The form requires immediate notification to the state of any changes in service locations, with the understanding that the state can terminate the contract if services are moved outside the United States without proper authorization.
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| File | Type | Posted |
|---|---|---|
| Aegis_Training_Solutions_Contract___CTR032298.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: ___________________________________
| Address: 9477 Silverside Dr |
| City State Zip: South Lyon, MI 48178 |
| Name: n/a |
| Address City State Zip: n/a |
| Name_2: n/a |
| Address City State Zip_2: n/a |
| Address_2: TBD |
| City State Zip_2: Columbus, OH |
| Name_3: n/a |
| Address City State Zip_3: n/a |
| Name_4: n/a |
| Address City State Zip_4: n/a |
| Address_3: 9477 Silverside |
| City State Zip_3: South Lyon, MI 48178 |
| Name_5: n/a |
| Address City State Zip_5: n/a |
| Name_6: n/a |
| Address City State Zip_6: n/a |
| By: Matt Smith |
| Print Name: Matt Smith |
| Title: Aegis Training Director |
| Date: 6.16.2025 |
File details come from the government source that posted it. Updated .