affirmation_and_disclosure_form__5_.pdf

This document is an Affirmation and Disclosure Form related to an Executive Order (2022-022D) concerning government contracts, specifically addressing restrictions on services performed by Russian companies or institutions. The form is completed by Isco Industries, Inc., a contractor agreeing to comply with federal and state guidelines regarding service locations, data storage, and potential limitations on international business operations.

The form requires the contractor to affirm that no services will be performed in Russia, and the company must disclose the principal business location, service performance locations, and data storage sites. The document references Executive Order 2019-12D, which generally prohibits offshore services by the State of Ohio, and mandates compliance with restrictions on purchasing services from Russian entities. The contractor agrees to immediately notify the State of any changes in service locations and understands the State retains the right to terminate the contract if these conditions are not met.