1-mentor__1.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The form is tied to Executive Order 2022-02D and its prohibition on Russian service providers, with implications for state agencies and contractors operating under this order. The contractor, RC County Maintenance, provides their principal business location at 7315 Welmar Dr. and indicates their service location as 10-01 State Route 7.

The document emphasizes compliance with restrictions on expenditure of public funds, particularly concerning services that might be performed by Russian companies or institutions. The contractor affirms they will not perform services outside the United States and agrees to complete the attached Exhibit II, which details contractor and subcontractor affirmations. The form specifically references Executive Order 2019-12D, which generally prohibits purchasing offshore services by the state, and the contractor acknowledges that ODOT (presumably the Ohio Department of Transportation) reserves the right to recover funds and pursue remedies if contract terms are violated. The form requires disclosure of business locations, service performance locations, and state data locations, with the understanding that failure to provide this information may result in contract non-award.