05062025091514-0001.pdf

This document is an Affirmation and Disclosure Form for a contractor, specifically completed by a representative from the company (signed by Paul R. Weston, Finance Manager). The form requires disclosure of business locations, service performance sites, and subcontractor information, with all listed locations in Mansfield, OH 44902-02. The primary contractor and a subcontractor named St. Peter Parish are identified, with locations at 104 W. 1st St. and services to be performed at 1150 N. Main St., also in Mansfield.

The form requires the contractor to affirm understanding of Executive Orders regarding offshore service restrictions and to disclose any potential changes in service locations. The document mandates immediate notification to the State of any shifts in service locations and acknowledges the State's right to terminate the contract if services are moved outside the United States. The form was signed on 5/6/2025, indicating it is part of a larger contract preparation or compliance process, though specific contract details are not fully elaborated in this disclosure document.