802-26_Executed_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Executive Business Solutions (the contractor) and the Ohio Department of Transportation (ODOT). The form addresses compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions, with the contractor located in Columbus, Ohio, and a subcontractor (The Glenhill Road Machinery Co.) from South Galion, Ohio.

The services will be performed at 440 N Old State Road in Delaware, Ohio, with state data to be located at the same address. The document emphasizes strict prohibitions on using Russian companies or services, in line with Executive Order 2019-12D, and requires full disclosure of business locations and service performance sites. The form is dated 06/03/2005 and was signed by the company's President/CEO, affirming the contractor's commitment to comply with state requirements and potential restrictions on offshore services.