097a-23_STS_Affirmation.pdf

This document is an Affirmation and Disclosure Form (Invitation No. 097a-23) for a state contract involving a contractor located in Gulf Breeze, Florida. The form pertains to the State of Ohio and addresses compliance with Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The contractor, with its principal business location at 2911 Westfield Road in Gulf Breeze, Florida, will perform services at 5676 Westbourne Avenue in Columbus, Ohio.

The contractor affirms understanding of the contract requirements, including the prohibition on purchasing services from Russian companies or institutions. The service location is specified as 5676 Westbourne Avenue in Columbus, Ohio, with the state data to be located at the contractor's principal business address in Gulf Breeze, Florida. No subcontractors are listed on the form. The document was signed by the contractor's President on 1/27/2023, indicating the company's commitment to abide by the state's requirements and to disclose any changes in service locations or contract conditions.