1-Affirmation_and_Disclosure_Form_Ohio.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by Gamma Scientific Inc., DBA UDT Instruments RoadVista, located at 9925 Carroll Canyon Road in San Diego, CA 92131. The document emphasizes compliance with state regulations, particularly concerning services performed outside the United States and restrictions on expenditures involving Russian companies or institutions.

The contract explicitly states that no subcontractors will be used, and all services will be performed from the contractor's primary location in San Diego. The form highlights prohibitions stemming from Executive Order 2019-12D, which restricts services from Russian companies or institutions. The contractor affirms adherence to these requirements and understands that failure to comply could result in contract termination. The document is signed by a Sales/Customer Service representative and dated 7/21/2025, indicating a future contract period with potential significance for state procurement and service delivery.