Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to Executive Order 2022-02D, which prohibits Russian companies or institutions from performing services for state agencies. The form is completed by a contractor located at 1060 Elizabeth St. #8 in Nicholasville, KY 40356, affirming compliance with restrictions on services from Russian companies or institutions in connection with a state contract.

The form indicates that the contractor will perform services at the same location as their principal business address, with no subcontractors listed. The document requires the contractor to confirm that no services will be performed in Russia and that they agree to comply with the executive order's provisions. The form was signed by a representative on 11-15-23, certifying the contractor's understanding of the restrictions on public fund expenditures and the potential for contract termination if these conditions are not met.