1-Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Jake Swearny Chrysler Jeep Dodge Ram (the contractor) and potentially the Ohio Department of Transportation (ODOT). The primary contractor is located at 85 W Kemper in Cincinnati, OH 45246, with a subcontractor named KE Rose Company located at 4595 Chambersburg Rd. in Huber Heights, OH 45424. The form addresses compliance with Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions.

The form outlines the locations where services will be performed, which are identical to the principal business locations (85 W Kemper in Cincinnati, OH). It requires the contractor to affirm that no services will be performed outside the United States without a signed waiver, and that they are not conducting business with Russian entities. The document is signed by Zachary Swearny, General Manager/Partner, on 6/26/25, and is part of a contractual agreement that includes provisions for immediate contract termination if the contractor fails to disclose changes in service locations or violates the specified restrictions on Russian business interactions.