1-doc03834920250424110241.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and Sandy's Auto + Truck Service Inc. The form addresses compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The contractor (Sandy's Auto + Truck Service Inc.) is located at 1541 S. Broadway St. in Dayton, Ohio 45417, and is affirming its commitment to performing all contract services within the United States.

The form requires the contractor to disclose the location of its principal business, where services will be performed, and where state data will be located, all of which are listed as the same Dayton, Ohio address. The contractor agrees to complete Exhibit II, which is incorporated into the contract, and affirms that no services will be performed in Russia. The document emphasizes the contractor's obligation to disclose any changes in subcontractor locations and to notify the state immediately of any such shifts. The form was signed on 4/24/25 by Doug Thomas, who is listed as the SEC (likely Secretary) of Sandy's Auto + Truck Service Inc.