2-Signed_Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form from the Ohio Department of Transportation (ODOT), executed by Southeastern Equipment Company. The form relates to Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions in response to Russia's actions. The contractor, located in Cambridge, Ohio, is affirming compliance with this order and providing details about their business and potential service locations.

The form requires the contractor to disclose their principal business location, any subcontractors, and locations where services will be performed. Specifically, Southeastern Equipment Company confirms that no services under this contract will be performed in Russia, and they agree to immediately notify the State of any changes in service locations. The document emphasizes ODOT's right to recover funds and terminate the contract if the contractor violates the restrictions on Russian business involvement. The form is signed by a sales representative and dated for November 17, 2025, indicating a future contract or compliance commitment.