1-Signed_Affirmation_1.pdf

The document is an Affirmation and Disclosure Form related to a state contract, specifically involving Haas Septic & Portable Toilet Services, Inc., located in Lower Salem, Ohio 45745. The form is associated with Executive Order 2022-02D and pertains to services to be performed within the state of Ohio, with all details submitted in compliance with state procurement regulations and the Ohio Department of Transportation (ODOT) requirements.

The form indicates that the contractor will perform services at 12411 OH-821 in Lower Salem, OH, with no subcontractors listed. The document emphasizes compliance with Executive Order 2019-12D, which generally prohibits offshore services and requires disclosure of service locations. The contractor affirms that no services will be performed in Russia, and they agree to immediately notify the state of any changes in service location. The form is signed by the owner, with an execution date of 6-10-2025, and is part of a broader contractual agreement with the state of Ohio.