041-25_Affirmation.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The contractor, Bain Enterprises, located at 4650 Allen Road in Stow, OH 44224, is completing this form in compliance with Executive Order 2022-02D. The form requires disclosure of business locations, service performance sites, and data storage locations, with a specific focus on prohibiting services by Russian entities.

The document outlines that the contractor will not perform any services for the state in Russia and affirms compliance with restrictions on purchasing offshore services. A subcontractor, Ver-Mac Jam Logic, is listed with an address in Manassas, VA 20109. The form was signed by Lori Wilhoit, President of Bain Enterprises, on 3/22/24, indicating the contractor's commitment to abide by the executive order's requirements regarding service locations and potential restrictions on international service provision.