1-scan0013.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements for services performed by Russian companies or institutions. The form is tied to Executive Order 2022-02D, which prohibits state agencies from purchasing offshore services. The contractor, MOSolutions, is based in Plain City, OH, and is completing this form as part of a contract with ODOT (Ohio Department of Transportation).

The form confirms the contractor's principal business location, service performance location, and state data storage location as being the same address. No subcontractors are listed, and the document emphasizes compliance with restrictions on offshore services. The contractor agrees to notify the state of any changes in service locations and understands that failure to provide complete information may result in no contract award. The form was signed by Neil Lacy, Sales Manager, on 6-2-25, and is intended to be incorporated into the broader contract with the state.