Updated Offshore Form.pdf
PDF 98 KB Posted
- Attached to
- JFS-OIS-Mobile Application and Website Testing Software Solution State and local contract opportunity
- Solicitation number
- SRC0000034975
- Issued by
- Ohio
About this file
This is a Standard Affirmation and Disclosure Form issued by the Ohio Department of Job and Family Services pursuant to Executive Order 2022-02D, which implements Ohio's response to Russia's unjust war on Ukraine as of March 2022. The form is mandatory for inclusion in all invitations to bid, requests for proposals, state term schedules, multiple award contracts, requests for quotations, informal quotations, and statements of work. Contractors must affirm that they have read and understand the applicable Executive Orders prohibiting the performance of offshore services, locating state data offshore, and purchasing from Russian institutions or companies. The form requires contractors to disclose the principal location of their business, all locations where services will be performed, and all locations where state data will be located, including information for any subcontractors used.
Contractors must provide complete name and address information for themselves and all subcontractors in the designated sections. Failure to provide this information may result in no award. Contractors are required to disclose any changes or shifts in service location before, during, and after contract execution and must notify the State immediately of such changes. The State retains the right to immediately terminate any contract if services are performed outside the United States unless the State issues a duly signed waiver. The authorized contractor representative must sign the form, certifying they are duly authorized to execute the affirmation and that the form becomes an incorporated part of any resulting contract with the State. No pricing, set-asides, incumbents, or specific funding information is contained in this form, as it serves solely as a compliance and disclosure document.
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Text version
OHIO DEPARTMENT OF JOB AND FAMILY
SERVICES
STANDARD AFFIRMATION AND DISCLOSURE
FORM
EXECUTIVE ORDER 2022-020
State of Ohio's Response to Russia's Unjust War on the Country of Ukraine
March 2022
All of the following provisions must be included in all invitations to bid, requests for proposals, state term schedules, multiple award contracts, requests for quotations, informal quotations, and statements of work. This information is to be submitted as part of the response to any of the procurement methods listed.
AFFIRMATION AND DISCLOSURE FORM
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)
(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):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
3. Location where state data will be located, by Contractor:
(Address) (City, State, Zip)
Name/Location(s) where state data will be located by subcontractor(s):
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
(Name) (Address, City, State, Zip)
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:
File details come from the government source that posted it. Updated .