1-186-26_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Bluffton Recreation, Inc. located in Bluffton, Ohio. The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The document requires contractors to disclose their principal business location, service performance locations, and state data storage sites, with this particular contractor listing 9485 Schifferly Rd. in Bluffton, Ohio 45817 as their primary address.

The form emphasizes strict requirements regarding offshore services and Russian business interactions, with the contractor affirming they will not perform any public or state services using Russian companies or institutions. No specific goods or services are detailed in this form, which appears to be a standard compliance document ensuring contractor eligibility for state contracts. The form was signed by Missy Ray, Office Manager of Bluffton Recreation, Inc. on 3.18.25, and requires disclosure of any changes in service locations or business operations that might occur before, during, or after contract execution.