2-Affirmation___Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by Environment Control Southwest Ohio Incorporated, located in Tipp City, Ohio. The document pertains to restrictions on services performed by Russian companies or institutions, in accordance with an Ohio state contract governed by Executive Order 2019-12D.

The contractor has identified its principal business location at 7939 S County Rd 25-A Ste A in Tipp City, and the location where services will be performed at 4444 SR 29 in Celina, Ohio. No subcontractors are listed for this contract. The form affirms that the contractor will not perform services outside the United States, will not allow state data to be sent outside the United States, and agrees to immediately notify the state of any changes in service locations. The document is signed by the COO/Owner, indicating authorization to execute the form and acknowledging its incorporation into any potential state contract.