Standard Affirmation & Disclosure Form_fillable PDF Form.pdf
PDF 267 KB Posted
- Attached to
- Veto Lake, Bow Range, L&D 18 Mowing and Litter
- Solicitation number
- SRC0000029329
- Issued by
- Franklin County, Ohio
About this file
This document is a Standard Affirmation and Disclosure Form related to a state contract opportunity, designed to ensure that contractors and their subcontractors perform services within the United States. The form requires contractors to disclose the principal business location, service performance locations, and data storage locations for both the primary contractor and any subcontractors. Contractors must affirm that no services will be performed outside the United States, and that state data will not be sent, accessed, or stored remotely outside the country without a specific waiver from the state.
The form mandates that contractors immediately notify the state of any changes in service or data location before, during, or after contract execution. Failure to provide complete location information may result in contract non-award. The document includes provisions for potential contract termination if services are moved outside the United States without proper authorization. The form must be signed by an authorized representative of the contractor, acknowledging understanding of these requirements and that the form is incorporated into the final contract.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: __________________________________
| Address: |
| City State Zip: |
| Name: |
| Address City State Zip: |
| Name_2: |
| Address City State Zip_2: |
| Address_2: |
| City State Zip_2: |
| Name_3: |
| Name_4: |
| Address City State Zip_3: |
| Address City State Zip_4: |
| Address_3: |
| Address City State Zip_5: |
| Name_5: |
| Name_6: |
| Name_7: |
| Name_8: |
| Name_9: |
| Address City State Zip_6: |
| Address City State Zip_7: |
| Address City State Zip_8: |
| Address City State Zip_9: |
| Address City State Zip_10: |
File details come from the government source that posted it. Updated .