1-Affirmation_and_Disclosure_BTR.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The form is executed by Depart Towing & Repair LLC, located at 1015D Avon Lake Rd in Burbank, OH 44214, and appears to be associated with the Ohio Department of Transportation (ODOT) and Executive Order 2022-02D, which prohibits state agencies from purchasing offshore services.

The form confirms that all services under the contract will be performed at the company's primary business location in Burbank, OH, with no subcontractors involved. The contractor affirms that no services will be performed in Russia and agrees to immediately notify the state of any potential changes in service location. The document was signed by the company's CDO on 4/28/2025, indicating compliance with state requirements for contract participation, particularly those related to geographical service restrictions and data handling.