2-05_-_ODOT_044-26_Affirmation___Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements for performing services and handling state data. The contractor is Stoops Freightliner - Quality Trailer, located at 7800 Center Point 70 Blvd in Dayton, Ohio 45424. The form pertains to compliance with Executive Order 2022-02D, which includes restrictions on services performed by Russian companies or institutions, and is associated with the Ohio Department of Transportation (ODOT).

The form outlines the contractor's obligations regarding service locations, data storage, and performance restrictions. The primary location for business and service performance is the same address in Dayton, Ohio. The company indicates that information is stored in a company-wide data system, with only sales information being saved. The document emphasizes the contractor's commitment to not performing services in Russia and to immediately disclosing any changes in service locations to the state. The form was signed by Gary Schmaltz, a Sales Representative, on 10-1-2025, affirming the company's understanding and compliance with the specified contractual requirements.