212-25_Affirmation_and_Disclosure_-_Firelands_Supply_Company.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Firelands Supply Co. located in Norwalk, Ohio. The form addresses compliance with Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions. The document requires the contractor to disclose their principal business location, service performance locations, and state data storage locations, all of which are listed as 18 South Norwalk Road West in Norwalk, Ohio 44857.

The form emphasizes restrictions on purchasing services from Russian entities, with implications for state agencies and contractors. It requires the contractor to affirm that no services under this contract will be performed in Russia, and that they are not violating the executive order's provisions. The document is part of a broader compliance mechanism that allows the state to immediately terminate the contract if the contractor fails to disclose changes in service locations or violates the restrictions on Russian-related services. The form is signed by Debra S. Wellfle, VP of Firelands Supply Co., with a signature date of 7/15/2024.