1-Schaffers_Trip_PW20250404_17041177_0318.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is completed by Schaffers Towing, located in Cinti, Ohio, and addresses requirements outlined in Executive Order 2022-02D concerning services performed by contractors.

The form details the contractor's principal business location at 4270 Harrison Ave in Cinti, Ohio, and the location where services will be performed at 3605 Dawson Ave in Cinti, Ohio. The document emphasizes compliance with regulations prohibiting the expenditure of public funds on services performed by Russian companies or institutions, in alignment with Executive Order 2022-02D and related state procurement guidelines. The contractor affirms that no services under this contract will be performed in Russia, and they are obligated to disclose any changes in service locations to the state, with the understanding that the state can immediately terminate the contract if such changes occur.