Standard Affirmation & Disclosure Form_fillable PDF Form (9).pdf
PDF 267 KB Posted
- Solicitation number
- SRC0000034146
- Issued by
- Clermont County, Ohio
About this file
This is an Affirmation and Disclosure Form related to a state contract that requires explicit documentation of service and data locations. The form mandates that the Contractor and any subcontractors perform all contract services within the United States and affirm that no state data will be sent, accessed, maintained, or stored outside of the United States without obtaining a specific waiver from the state. The Contractor is required to provide comprehensive details about their principal business location, service performance locations, and data storage locations for both the primary Contractor and any potential subcontractors.
The document emphasizes ongoing disclosure obligations, stipulating that the Contractor must immediately notify the state of any changes in service or data location before, during, and after contract execution. The state retains the right to immediately terminate the contract if unauthorized location shifts occur, unless a signed waiver is obtained. The form must be signed by an authorized representative of the Contractor, who acknowledges understanding that this document is incorporated into any potential contract with the state and represents a binding commitment to maintain domestic service and data management practices.
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| File | Type | Posted |
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| Standard Terms and Conditions (9).pdf | ||
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys.docx | DOCX document | |
| Scope of Work Structure #4.docx | DOCX document | |
| OPERS Independent Contractor Form_fillable PDF Form (9).pdf |
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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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