1-Affirmation___Disclosure_1.pdf

This document is an Affirmation and Disclosure Form related to a state contract, completed by Green Climber of North America Inc. The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The primary contractor is Green Climber of North America Inc., located in Burn Ridge, IL, with two subcontractors listed: Babuk Enterprises and Zimmer Tractor, both located in Ohio.

The form indicates that services will be performed at locations to be specified in a separate list of service locations. The contractor affirms that no services will be performed in Russia and agrees to complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form. The document was signed by the Vice President on 5/6/2023, certifying compliance with the executive order's requirements regarding offshore services and potential contract termination if services are performed in Russia. The form serves as a formal disclosure of business locations, service performance sites, and data storage locations for the contracted services.