Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is completed by Perkins/Jauner Construction LLC, located in Milford, OH, and addresses compliance with Executive Order 2022-02D regarding services performed by contractors and subcontractors. The form emphasizes restrictions on services from Russian companies or institutions, in line with current state and federal guidelines.

The contract specifies that services will be performed at 6005 Meijer Drive in Milford, OH 45150, with state data to be located at the same address. No subcontractors are listed on the form. The document highlights the contractor's agreement to abide by Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions. The form requires disclosure of any changes in service locations and gives the state the right to terminate the contract if these conditions are not met, underscoring the stringent compliance requirements for this government contract.