Affirmation_and_Disclosure_Form__3_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed by Russian companies or institutions. The form is completed by Southeastern Equipment, located at 10874 East Pike Road in Cambridge, Ohio 43725, and is associated with Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions.

The form requires the contractor to affirm that no services under this contract will be performed in Russia, and it mandates compliance with Executive Order 2019-12D regarding offshore services by the State of Ohio. The contractor agrees to complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, and acknowledges the obligation to disclose any changes in service locations before, during, and after contract execution. The document is signed by Ryan Tarosik, Sales Representative, on 10-30-24, indicating the company's commitment to these contractual requirements.