3-Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form for Geoprobe Systems, KEJR INC, related to a contract governed by Executive Order 2022-022, which appears to involve the Ohio Department of Transportation (ODOT). The form specifically addresses restrictions on services performed by Russian companies or institutions, with the contractor affirming compliance with guidelines prohibiting certain international service arrangements.

The contract's primary location of business is listed at 1835 Wall Street in Salina, Kansas, with all services to be performed at the same address. The document requires the contractor to disclose any potential use of subcontractors and affirm that no services under this contract will be performed in Russia. The form is part of a broader regulatory framework preventing the purchase of services from Russian entities, with ODOT reserving the right to recover funds paid for services under this contract. The document is signed by the company president and dated 8/6/2025, indicating a future contract period.