1-Affirmation___Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically for the Ohio Department of Transportation (ODOT) under Executive Order 2022-02D. The form is completed by Englewood Truck Shop, Inc. (doing business as Englewood Truck Towing & Recovery), located at 7510 Jacks Ln. in Clayton, OH 45315. The document is designed to affirm compliance with restrictions on services from Russian companies or institutions in accordance with state procurement guidelines.

The form indicates that all services will be performed at the company's primary business location in Clayton, Ohio, with no subcontractors involved. The contractor agrees to complete the attached Exhibit II and comply with the Executive Order's provisions prohibiting the purchase of services from Russian companies or institutions. The document serves as a formal affirmation that the company will not engage in any contract activities involving Russian entities and will immediately notify the state of any potential changes in service locations or subcontractor arrangements.