Affirmation_and_disclosure_form__13_.pdf

This document is an Affirmation and Disclosure Form related to an Ohio Department of Transportation (ODOT) contract, specifically addressing requirements under Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by Southwestern Equipment Co., located at 10874 E. Pike Rd. in Cambridge, OH 43725, and is designed to ensure compliance with restrictions on engaging with Russian entities.

The document indicates that the contractor will not be using subcontractors and has affirmed that no services under this contract will be performed in Russia. The form requires disclosure of business locations, service performance locations, and state data storage locations, all of which are marked as "N/A" in this instance. The contract emphasizes ODOT's prohibition on purchasing services from Russian companies or institutions, with the state reserving the right to recover funds and terminate the contract if such restrictions are violated. The form was signed by a Sales Representative on 3-19-25, certifying the company's understanding and compliance with the specified executive order.