Affirmation_and_Disclosure__18_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by Utility Truck Equipment, located at 23893 US Hwy 23 S in Circleville, OH 43113. The document affirms the contractor's commitment to not perform any services in Russia and to adhere to state procurement restrictions associated with Russian-related business activities.

The form indicates that all services will be performed at the company's primary business location in Circleville, Ohio, with no services to be conducted outside the United States. The contractor agrees to complete the attached Exhibit II, which is incorporated into the contract, and confirms that neither the contractor nor its subcontractors will perform any services in Russia. The document requires an original signature and includes provisions for notifying the state of any changes in service locations or contract terms, with the state retaining the right to immediately terminate the contract if such changes occur without proper notification.