1-Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically for Fabick Technology Services located in Fenton, Missouri. The form is tied to Executive Order 2022-020 and pertains to potential services performed under Ohio Department of Transportation (ODOT) contract guidelines, with specific provisions regarding services performed by Russian companies or institutions.

The form indicates that Fabick Technology Services, represented by Jack Sagaitis (Technology Sales Specialist), has affirmed they will not perform any contract services in Russia and have no subcontractors planned for this contract. The principal business location is 1 Fabick Dr, Fenton, MO 63026. While specific service details are not elaborated in this document, the form emphasizes compliance with state regulations, particularly around potential restrictions on services from Russian companies, and reserves ODOT's right to recover funds if contract terms are not met.