Standard Affirmation Disclosure Form fillable PDF Form.pdf

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Attached to
PWC SW M Rocky Fork John Deere Mower and Buckets with Trade Ins
Solicitation number
SRC0000018121
Issued by
Hocking County, Ohio

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This document is an Affirmation and Disclosure Form related to a state and local contract opportunity from the State of Ohio. The contract is for the purchase of Qty 1 John Deere Z970R ZTrak Mower and Qty 2 - 72 Inch Buckets, Construction and Tooth, with the State willing to accept Qty 5 Trade-in Equipment Items. The project will be located at Rocky Fork State Park in Hillsboro, Ohio. The delivery date is prior to June 2024. The contract will be awarded to the lowest responsive and responsible bidder. Bidders are encouraged to visit the site prior to submitting a bid, and failure to do so will not be an acceptable reason to be released from the contract.

The pricing terms include unit costs for the mower and buckets, as well as trade-in allowances for the Qty 5 items. The State of Ohio allows for a 5% price preference for Veteran-Friendly Business Enterprises, as well as Buy Ohio and Buy American preferences of up to 5-6%. Invoices must be submitted directly to Ohio Shared Services, and the contract is only valid for goods and services received through June 30, 2024.

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Other files

File Type Posted
PWC SW RFQ RockyFork John Deere Mower and Buckets with Trade Ins Amended.pdf PDF
Standard_T_C_04-10-23.pdf PDF
Ohio Buys New Bidder.pdf PDF
S-LG.2 Ohio Buys Viewing and Responding to Solicitations LG v2.0.pdf PDF

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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 .