Affirmation_and_Disclosure_Form__11_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Kleinfelder, Inc. as the contractor. The form addresses requirements under Executive Order 2022-02D, focusing on restrictions for services performed by Russian companies or institutions. The primary location of business is 2926 US Hwy 6 in McClure, OH 43534, with a secondary location at 4637 Northwest Pkwy in Hilliard, OH 43026.

The document outlines the contractor's commitment to performing services within the United States and affirming no services will be conducted in Russia. It requires disclosure of business locations and service performance sites, and mandates notification to the State of any changes in service locations. The form is part of a larger contract process, with the contractor agreeing to abide by executive orders prohibiting state agencies from purchasing services from Russian companies. The form is signed by Dingfang Liu, KWT Area Manager, with an execution date of 11-13-2025, indicating a multi-year agreement or potential contract period.