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This document is an Affirmation and Disclosure Form for Kufner Towing Inc., located at 3775 Ridge Rd in Cleveland, Ohio 44144. The form is associated with a state contract, specifically addressing requirements related to Executive Order 2022-02D concerning services performed by Russian companies or institutions. The document appears to be part of a contract submission to the Ohio Department of Transportation (ODOT), with the contractor affirming compliance with specific state guidelines and restrictions.

The form outlines the contractor's commitment to performing services exclusively within the United States, with explicit prohibition on utilizing Russian companies or institutions for contract services. The document requires disclosure of business locations, service performance sites, and state data storage locations, all of which are listed at the same Cleveland address. The contractor, represented by Dale Kufner in the role of President, signed the document on 02/26/25, agreeing to immediately notify the state of any changes in service locations and understanding that the state reserves the right to terminate the contract under certain circumstances.