Affirmation_and_Disclosure_Form__15_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by Southeastern Equipment Co., located at 10874 E Pike Rd. in Cambridge, OH 43725, and is designed to ensure the contractor's adherence to restrictions on engaging with Russian entities in the context of a state contract.

The form focuses on verifying the contractor's principal business location, service performance locations, and data storage sites, while explicitly prohibiting the use of Russian companies or institutions in contract services. The document requires the contractor to affirm compliance with Executive Order 2022-02D and Executive Order 2019-12D, which restrict purchases from Russian companies and offshore services. The form is signed by Ryan Tacosik, Sales Representative, on 6-19-24, indicating the current date of submission and the company's commitment to these contractual requirements.