019-25_Affirmation__Disclosure_Form_MMS.pdf

This document is an Affirmation and Disclosure Form for a contract involving Moriarty Machinery & Supply Inc., located at 143 Broadway St. in Toledo, OH 43601. The form is associated with the State of Ohio and addresses compliance with Executive Order 2022-02D, which prohibits the use of public funds for services performed by Russian companies or institutions. The contractor affirms that no services under this contract will be performed in Russia, and the primary location of business and service performance is in Ohio.

The form indicates that the contractor will not be using any subcontractors, with all fields for subcontractor information marked as "N/A". The document emphasizes compliance with state regulations regarding the expenditure of public funds, specifically noting restrictions on purchasing services from Russian companies. The contractor agrees to immediately notify the state of any changes in service location or contract details, and acknowledges that the form is incorporated into any contract with the state. The document was signed by the company president on 8-21-2024, certifying the accuracy of the disclosed information.