Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form for a contractor, completed by Diana Lutz in her capacity as Office Manager. The principal business location is 210 W. Main St. in St. Clairsville, OH 43950. The form indicates that the contractor will perform services at the Belmont Correctional Institution located at 68518 Barnett Rd. in St. Clairsville, OH 43950. No subcontractors are listed, with "N/A" noted in those sections.

The form affirms that the contractor understands they are prohibited from performing services outside the United States without a signed waiver from the state. The document requires disclosure of service locations and data storage sites, which in this case are both at the main business address. The contractor also acknowledges an ongoing obligation to immediately notify the state of any changes in service location before, during, or after contract execution, with the state retaining the right to terminate the contract if services are moved outside the United States.