1-Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a contract governed by Executive Order 2022-02D, specifically addressing restrictions on services performed by Russian companies or institutions. The form involves Jake Swearny Chrysler Jeep Dodge Ram (the Contractor) and KE Rose Company (a subcontractor), both located in Ohio. The primary location of business and services is 85 W Kemper in Cincinnati, OH 45246, with KE Rose Company located at 4595 Chambersburg Rd. in Huber Heights, OH 45424.

The document affirms compliance with executive orders prohibiting state agencies from purchasing services from Russian entities, with specific reference to ODOT (Ohio Department of Transportation) restrictions. The contractor agrees to complete an attached Exhibit II and acknowledges potential contract termination if services are performed in Russia. The form requires disclosure of business locations, service performance locations, and state data storage locations, all of which are within Ohio. The document was signed by the General Manager/Partner on 6/26/25, indicating the current contractual agreement and the contractor's commitment to abide by the specified executive order restrictions.