1-AFFIRMATION_AND_DISCLOSURE_FORM_FOR_118-25__.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements outlined in Executive Order 2022-02D concerning Russian companies and institutions. The form is completed by Valley Ford Truck Inc., located at 5715 Canal Rd. in Cleveland, Ohio 44125, and is part of a contractual agreement with the state. The document affirms that the contractor will not perform services outside the United States and will not use Russian companies or institutions in the performance of the contract.

The form details the contractor's principal business location, service performance location, and state data location, all of which are at the same address in Cleveland, Ohio. There are no subcontractors listed (marked as "N/A"). The contractor agrees to comply with Executive Order 2019-12D, which prohibits state agencies from purchasing offshore services from Russian companies. The document requires an original signature, which is provided by Michele Stebner, Vice President of Valley Ford Truck Inc., on 6/12/25, affirming the company's compliance with the specified contractual and executive order requirements.