Affirmation_and_Disclosure__20_.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 Site Safe, LLC, with a principal business location in Litchfield, KY, and a service performance location in Columbus, OH. The document relates to Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions and requires contractors to affirm compliance with these restrictions.

The contract involves services to be performed at 1500 Oleta Rd. in Columbus, OH 43207, where state data will also be located. The contractor affirms understanding and agreement to abide by Executive Order 2019-12D, which generally prohibits offshore services by the State of Ohio. The form requires the contractor to disclose any changes in service locations and grants the state the right to immediately terminate the contract if these terms are not met. No specific goods, services, pricing terms, or contract amounts are detailed in this particular document, which appears to be a compliance and disclosure form focused on geographic and operational restrictions.