1-Signed_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a contract involving the Ohio Department of Transportation (ODOT) and Northwestern Ohio Security Systems, Inc. The form addresses requirements under Executive Order 2022-022, specifically concerning services performed by or involving Russian companies or institutions. The form requires disclosure of the contractor's principal business location, subcontractors, and service locations, with an emphasis on compliance with restrictions on engaging with Russian entities.

The contractor, Northwestern Ohio Security Systems, Inc., indicates its principal business is located in Lima, OH, with potential subcontractors including DC3 Security and Acumen Bldg Solutions. The services are to be performed across all 88 counties, with no specific state data location noted. The form highlights prohibitions on purchasing services from Russian companies or institutions, stemming from Executive Order 2019-12D, and reserves ODOT's right to recover funds paid for services under the contract. The document requires an original signature and serves as a binding affirmation that no services will be performed by subcontractors in Russia.