Affirmation_And_Disclosure__13_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The form is completed by SealMaster Mfg of America Inc., with primary business locations in Hillsville, PA and a service location in Youngstown, OH. The document is tied to Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions.

The contract involves no subcontractors, as indicated by "Not Applicable" entries throughout the form. The primary location of business is 4551 W. State St. in Hillsville, PA, with service performance location at 430 N. Meridian Rd in Youngstown, OH. The form was signed by Michael Rich, Sales Manager/Assistant VP, on 01/06/2025, affirming compliance with state regulations regarding public funds expenditure and service restrictions related to Russian entities. The document serves as a mandatory disclosure and affirmation of the contractor's commitment to these terms for potential state contract engagement.