AFFIRMATION_AND_DISCLOSURE_FORM__6_.pdf

This document is an Affirmation and Disclosure Form from Kleis Equipment, located at 1824 Newgarden Rd. in Salem, OH 44460, for a contract with the Ohio Department of Transportation (ODOT). The form addresses compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions, and requires disclosure of contract and subcontractor locations and data handling practices.

The form does not specify the exact goods or services under contract, but it emphasizes strict guidelines for data management, particularly regarding services performed outside the United States. The contractor affirms that no services will be performed in Russia and agrees to immediate contract termination if there are any changes in subcontractor locations or service performance sites. The document requires original signature and was signed by Collin Gilbert in the Sales role on 12/19/24, indicating this is a current contractual document with ongoing compliance requirements.