1-Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D and its restrictions on services performed by Russian companies or institutions. The form is completed by Engels Air Service Inc., located at 4724 Springfield Road in Cincinnati, Ohio 45251, and is associated with a contract involving the Ohio Department of Transportation (ODOT).

The form details the contractor's principal business location, service performance location, and state data location, all of which are consistent at the same Cincinnati address. The document emphasizes the contractor's agreement to abide by Executive Order provisions prohibiting the purchase of offshore services by state agencies, and affirms that no services will be performed in Russia. The contractor commits to completing an attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, and acknowledges the potential for contract termination if these conditions are not met. The form was signed on 4/23/25 by the treasurer of Engels Air Service Inc., indicating the company's compliance with the specified contractual requirements.