Affirmation_and_Disclosure_Form__4_.pdf

This document is an Affirmation and Disclosure Form completed by DJL Material & Supply, Inc., located in Akron, Ohio, for a contract subject to Executive Order 2022-02D regarding services performed outside the United States. The form addresses restrictions on expenditure of public funds related to services performed by Russian companies or institutions, with specific compliance requirements for the contractor.

The contractor indicates their principal business location is P.O. Box 5293 in Akron, Ohio, with service performance location at 4361 State Road in Peninsula, Ohio. No subcontractors are listed on the form. The document emphasizes the contractor's agreement to abide by Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions, and requires immediate contract termination if the contractor changes or shifts service locations during the contract period. The form was signed by Michael Leahy, Manager, on 11/05/2024, affirming the company's compliance with the specified executive order requirements.