Affirmation_and_disclosure_form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing offshore services and prohibitions on purchasing from Russian institutions. The principal contractor is located at 9195 Seward Rd in Fairfield, OH 45014, with two named subcontractors: Mark Metzger and Hamio Pouvaril, both sharing the same business address.

The form details the locations where services will be performed, which are identical to the principal business address. It includes provisions requiring the contractor to disclose any changes in service locations and affirming an obligation to notify the state immediately of any shifts in service performance locations. The document emphasizes compliance with Executive Orders regarding offshore performance restrictions and provides a framework for potential contract termination if services are proposed to be conducted outside the United States without proper waiver. The form was signed by Mark Metzger on 1/4/23 in the capacity of Territory Sales Manager.