1-scan0005.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by MDsolutions, with a principal business location at 8225 Estero Pkwy in Plain City, OH 43064. The document is designed to ensure compliance with regulations regarding services performed, particularly emphasizing restrictions on services related to Russian companies or institutions.

The form confirms that no services will be performed in Russia, and the contractor (MDsolutions) agrees to abide by the executive order's requirements. The document specifies that the location where services will be performed and where state data will be located is the same as the principal business address. There are no subcontractors listed, and the form was signed by Neil Lacy in the Sales role on 4-15-25, affirming the company's commitment to not engage in any services prohibited by the executive order and to disclose any changes in service locations to the state.