007-25_Affirmation_and_disclosure.pdf

This document is an Affirmation and Disclosure Form related to Executive Order 2022-02D, specifically addressing contract requirements for Bain Enterprises. The form pertains to the Ohio Department of Transportation (ODOT) and outlines restrictions on services performed by Russian companies or institutions. The principal business location is listed as 4656 Allen Rd in Stow, Ohio 44224, with no subcontractors noted.

The document affirms that the contractor will not perform any services in Russia and agrees to comply with Executive Order 2019-12D, which prohibits state agencies from purchasing offshore services from the State of Ohio. The form requires disclosure of service locations, data storage sites, and commits the contractor to immediately notify the state of any changes in service locations. The form was signed by Lori Wilhoit, President of Bain Enterprises, on 1/6/25, and is part of a contractual agreement with the state, incorporating specific compliance requirements related to international service restrictions.