20240621143157556.pdf

This document is an Affirmation and Disclosure Form from Buckeye Power Sales, located at 7890 Robinett Way in Canal Winchester, Ohio 43110. The form is related to compliance with Executive Order 2022-02D, which addresses restrictions on public funds expenditure for services performed by Russian companies or institutions. The document appears to be part of a state contract, specifically involving the Ohio Department of Transportation (ODOT), and requires detailed disclosure about the contractor's business locations and service performance sites.

The form confirms that Buckeye Power Sales has no subcontractors and will perform all contract services at its primary business location in Canal Winchester, Ohio. The contractor affirms understanding of and compliance with executive orders prohibiting the purchase of services from Russian entities, and agrees to immediately notify the state of any changes in service locations. The document was signed by Martin L. Federer in the Sales role on 6/21/2024, and requires the contractor to complete an attached Exhibit II with additional Contractor/Subcontractor Affirmation and Disclosure details. No specific contract value, goods, or services are detailed in this particular document.