Affirmation_and_Disclosure_Form__2_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by Company West Ltd, with its principal business location at 16400 Beachpier Rd in Beachpier, OH 44135. The document pertains to the Ohio Department of Transportation (ODOT) and involves compliance with restrictions on services performed by Russian companies or institutions.

The form outlines the contractor's commitments regarding service locations and data storage, with the service location and primary business address being the same (16400 Beachpier Rd, Beachpier, OH 44135), and state data to be located at 4805 Scoosy Lane in Carroll, OH 43112. The contractor affirms no services will be performed in Russia and agrees to comply with the Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The document was signed by Gabriel D. Clark, Midwest Regional Sales Manager, on 1-28-25, and serves as a critical compliance document for potential state contract engagement.