Standard Affirmation & Disclosure Form_fillable PDF Form (10).pdf
PDF 267 KB Posted
- Attached to
- OWC - YSI EXO2 and Supporting Sensors
- Solicitation number
- SRC0000023308
- Issued by
- Hocking County, Ohio
About this file
This document is a State of Ohio Affirmation and Disclosure Form that must be completed by any contractor or subcontractor performing services for the State. The form requires the contractor to affirm that all services and data will be performed and stored within the United States, unless a waiver is obtained. The contractor must disclose the principal locations of their business and any subcontractors, as well as the specific locations where services will be performed and State data will be stored. The contractor acknowledges a duty to disclose any changes in service locations during the contract, which may result in the State terminating the contract if the services are moved outside the United States without a waiver.
The document outlines pricing and payment terms, as well as any set-asides, incumbent contractors, or funding sources. However, these details are not provided in the given file.
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Text version
Version 2/20 Page 1 of 2
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, nor 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
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 where services will be performed by Contractor:
(Address) (City, State, Zip)
Name/Location where services will be performed by subcontractor(s):
Version 2/20 Page 2 of 2
3. Location where state data will be located, by Contractor:
(Address) (Address, City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
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.
By: __________________________________ Contractor
Print Name: ___________________________
Title: __________________________________
Date: __________________________________
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File details come from the government source that posted it. Updated .