1-20250620_AFFIRMATION_AND_DISCLOSURE_FORM.pdf

A F F I R M AT I O N A N D D I S C L O S U R E F O R M

By the sاgnatu٢e affixed hereto, the Contractor affirms and understands ttiat If awarded acontract, botti the Contractor and any of its subcontractors Shalt perform no sendees requested under this Contract outside of the United States, not allow State data to be sent, taken, accessed, tested, maintained, backed-up, stored or made available remotely(located) outside of the United States unless aduly signed waiver from the state has been attained.

The Contractor shall provide all the name(s) and locatlon(s) where senrices under tills Contract will be performed and where data is located in the spaces provided below or by attachment. Failure to provide tills information may result in no award. If the Contractor will not be using subcontractors, indicate "Not Applicable" in the appropriate spaces.

EXPENDITURE ٥F PUBLIC FUNDS ON SERVICES PERFORMED BY RUSSIAN COMPANIES OR INSTITUTIONS.

The Contractor affirms to have read and understands Executive Order 2٥22-02D and sliall abide by those requirements in the performance of this Contract. Pursuant to this Executive Order, all state agencies are prohibited from the purctiase of senrices from Russian companies or institutions. This prohibition is in addition to and expands upon Executive Order 2٥19-12D whicli generally precludes the purchase of offshore services by the State of Ohio. Notwithstanding any other terms of this Contract, ODOT reserves the right to recover any funds paid for senrices the Contractor performs in Russia in violation of this Executive Order. ODOT does not waive any other rights and remedies provided to ODOT in this Contract.

The Contractor agrees to complete the attached Exhibit 11, Contractor/Subcontractor Affirmation and Disclosure Form, to abide with Executive Order 2022-02D, which is incorporated and becomes apart of this Contract, affirming no se^ices of the Contractor or its subcontractors under this Contract will be performed in Russia.

1. Principal location of business of Contractor:

4345 strlngtown Rd NW 4313٥ er, OH؛Lancas (City, State, Zip)(Address)

Name/Principal location of business of subcontractor(s):

N O N E

(Address, City, state. Zip)(Name)

(Address, City, state. Zip)(Name)

2. Location where senrices will be performed by Contractor:

4345 strlngtown Rd NW Lancaster, OH 43133 (City, State, Zip)(Address)

Name/location where senrices will be performed by subcontractor(s):

N O N E

(Address, city, state. Zip)(Name)

(Address, City, state. Zip)(Name)

Location where state data will be located, by Contractor:3.

Lancaster, OH 431334345 Str!ngtownRdNW (City, State, Zip)(Address)

Name/Locat!on(s) where state data will be located by subcontractor(s):

N O N E

(Address, City, state. Zip)(Name)

(Address, City, state. Zip)(Name)

(Address, City, state. Zip)(Name)

Contractor also affirms, understands and agrees that Contractor and its subcontractors are under aduty to disclose to the State any change or shift in location of services performed by Contractor or its subcontractors before, during and after execution of any contract with the state. Contractor agrees it shall so notify the state immediately of any such change or shift in location of its senrices. ftie state has the right to immediately terminate the contract, unless aduly signed waiver from the state has been attained by the Contractor to perform the services outside the United States.

On behalf of the Contractor, Iacknowledge that Iam duly authorized to execute this Affirmation and Disclosure Form and have read and understand that this form is apart of any Contract that Contractor may enter into with the state and is incorporated therein.

(AN ORIGINAL SIGNATURE IS REQUIRED)

Park Companies !nc Company Name:

Signature:. ع

M i c h e l e M B r o w n P r i n t N a m e :

V i c e P r e s i d e n ؛ Ti t l e :

6ه / 2 5 / 2 2ه 5D a t e :