Affirmation_and_Disclosure__6_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The contractor is located at 687 Palmetto Road in Tupelo, Mississippi 38801. The form emphasizes compliance with state regulations, particularly regarding services performed by Russian companies or institutions, and outlines strict prohibitions on state agencies purchasing services from Russian entities as part of ongoing geopolitical restrictions.

The form requires the contractor to disclose the principal location of business, service performance locations, and state data storage sites, all of which are currently situated in Tupelo, Mississippi. The document highlights that no services under this contract will be performed in Russia, and the contractor affirms compliance with Executive Order 2022-02D, which generally prohibits state agencies from purchasing services from Russian companies or institutions. The contractor, represented by the President who signed the document on 2.19.24, agrees to immediately notify the state of any changes in service locations or subcontractor details and acknowledges the right of the state to terminate the contract if international service restrictions are violated.