1-AFFIRMATION_AND_DISCLOSURE_FORM_1.pdf

This document is an Affirmation and Disclosure Form for a state contract, specifically executed by Blust Sales & Service, Inc. The form is related to an Executive Order 2022-02D, which includes restrictions on services performed by Russian companies or institutions. The contractor's principal business location is listed at 3254 McGill Lane, with a zip code of 64451.

The form outlines key contractual obligations, including prohibitions on using Russian companies or institutions for service procurement, as mandated by the Executive Order 2019-12D. The contractor agrees to complete an attached Exhibit II, which incorporates provisions stating that no services under this contract will be performed in Russia. The document requires disclosure of service locations, subcontractors, and data storage sites, though in this instance, those specific details are not filled out. The form emphasizes the state's right to immediately terminate the contract if these conditions are not met, and requires an original signature, which has been provided by Gary Blust on 4/16/2025.