095-23_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form for Invitation No. 095-23, completed by a contractor based in Lancaster, Ohio. The form is associated with the State of Ohio and specifically involves ODOT (Ohio Department of Transportation), addressing requirements related to services performed outside the United States, with particular emphasis on restrictions concerning Russian companies and institutions, as outlined in Executive Order 2022-02D.

The contractor, Vincent E. Messerly (President), has identified their principal business location as 123 S. Broad St., Suite 238 in Lancaster, OH 43130, which will also serve as the location for performing services and storing state data. The document affirms compliance with Executive Orders regarding the prohibition of purchasing services from Russian companies or institutions, and commits to completing the attached Exhibit II, which details the contractor's affirmation that no services under this contract will be performed in Russia. The form requires disclosure of potential subcontractors and locations where services might be performed, though in this instance, no subcontractors are listed.