120-26_affrimation_form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Guardian Recreation Systems, LLC. The form addresses compliance with Executive Order 2022-02D, which prohibits doing business with Russian companies or institutions. The contractor's principal location is 116 Cabin Creek Drive in Brooks, KY 40109, and the services will be performed in Ohio for the Ohio Department of Transportation (ODOT).

The form confirms that the contractor will not perform any services in Russia and agrees to abide by restrictions on purchasing services from Russian companies or institutions. The document serves as a certification that the contractor understands and will comply with state and federal requirements regarding business operations in relation to Russian entities. The form was signed on 1-13-25 by the Operations Manager, indicating the company's commitment to these contractual and governmental guidelines.