1-AFFIRMATION_AND_DISCLOSURE_FORM-POC.pdf

This is an Affirmation and Disclosure Form for Phillips Oil Ctrl Ohio Inc., located at 1877 McKinley Ave in Columbus, Ohio 43222. The document is specifically related to compliance with Executive Order 2022-020, which prohibits the purchase of services from Russian companies or institutions. The form is designed to confirm the contractor's business location, service performance location, and state data storage location, all of which are at the same Columbus, Ohio address.

The document affirms that the contractor will not perform any services in Russia and will comply with the state of Ohio's restrictions on engaging with Russian companies. No specific goods or services are detailed in this form, as it appears to be a standard compliance document ensuring the contractor's adherence to state procurement guidelines regarding international service restrictions. The form requires an original signature and was signed by the company's president on 4/2/25, validating the contractor's commitment to the specified terms and conditions.