2-023A-26_Aff___Disc_1.pdf

This document is a 1770 Affirmation and Disclosure Form related to an Ohio state contract involving Stoops Western Star of Ohio. The form is associated with Executive Order 2022-02D and addresses restrictions on services performed by Russian companies or institutions. The contractor (Stoops Western Star) is based in Wapakoneta, Ohio, and is submitting this form as part of a contract with the Ohio Department of Transportation (ODOT) for the 2022-2025 period.

The form primarily serves to document the contractor's principal business location, service performance locations, and state data storage sites, all of which are located at 1770 Wapak Fisher Rd in Wapakoneta, Ohio. The document emphasizes compliance with state regulations prohibiting the use of Russian companies or services, and requires the contractor to disclose any potential changes in service locations or subcontractors. The form is signed by Duane Hoersten in a Truck Sales capacity, with a signature date of 07/16/2025, and is part of the contractor's commitment to not perform any services in Russia or use Russian subcontractors under the state contract.