affirmation_10_24.pdf

This document is an Affirmation and Disclosure Form related to a state contract, primarily involving Alta Equipment Company located in Oakwood Village, Ohio. The form addresses compliance with Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The contractor (Alta Equipment Company) and its subcontractor (Midwest Mine Services) are both Ohio-based businesses that have disclosed their principal business locations and service performance locations.

The form specifically outlines the locations where services will be performed, with both the primary contractor and subcontractor operating from Ohio addresses: Alta Equipment Company at 181 Oak Leaf Oval in Oakwood Village, and Midwest Mine Services at 5050 Nike Drive in Hillard. The document requires the contractor to affirm that no services under this contract will be performed in Russia, in compliance with state procurement restrictions. The form is signed by Donald B. D'Onofrio, Governmental Segment Manager, on 10/07/2024, and includes provisions for immediate contract termination if there are undisclosed changes in service locations or violations of the specified executive order.