Affirmation_and_Disclosure__2_.pdf

This document is an Affirmation and Disclosure Form related to a contract involving ODOT (Ohio Department of Transportation) and OMJC Signal, Inc., located at 403 Chestnut St. in Waterloo, IA 50703. The form specifically addresses requirements related to Executive Order 2022-02D concerning services performed by Russian companies or institutions, with implications for contract execution and potential service locations.

The contract requires the contractor to affirm that no services will be performed in Russia, and any subcontractors must be disclosed. The document outlines the locations where services will be performed, which are consistently listed as 403 Chestnut St. in Waterloo, IA 50703. The form emphasizes ODOT's right to recover funds and terminate the contract if services are performed in violation of the executive order. The document is signed by Jennifer Shipp, President of OMJC Signal, Inc., with the signature dated 10/16/24, indicating compliance with the state's disclosure and affirmation requirements for government contracts.