Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing services performed in relation to Executive Order 2022-02D and prohibitions on services in Russia. The form is completed by Setterlin Building Co., located at 560 Harmon Ave. in Columbus, OH 43223, and is associated with a contract involving the Ohio Department of Transportation (ODOT). The form requires disclosure of the contractor's principal business location, service performance locations, and state data storage locations.

The contract appears to cover services for All District 6 Facilities, with the contractor affirming they will not perform services outside the United States or in Russia, in compliance with the referenced Executive Order. The document emphasizes the contractor's obligation to disclose any changes in service locations before, during, and after contract execution, and requires immediate notification to the State of any shifts in service locations. The form is signed by Jerry Amole, Special Projects Manager, with a signature date of 10/15/2024, and is part of a broader compliance mechanism for state contracts.