AFFIRMATION_AND_DISCLOSURE_FORM__4_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D regarding the expenditure of public funds. The contractor is located at 3390 Little Creek Rd in Frankfort, Ohio 45628, and will perform services within the State of Ohio. The form focuses on prohibiting the use of public funds for services from Russian companies or institutions, in response to the Russian invasion of Ukraine.

The contract involves services to be performed within Ohio, with state data to be located in Ohio. No subcontractors are listed (marked as N/A), and the contractor affirms that no services under this contract will be performed in Russia. The document requires the contractor to disclose any changes in service locations or subcontractors, with an obligation to notify the state immediately of any such shifts. The contractor has acknowledged understanding of the executive order's restrictions and agrees to comply with its provisions, including potential contract termination if services are attempted to be performed outside the United States.