AFFIRMATION_AND_DISCLOSURE_FORM_final__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Tiffin Aire, located at 1778 W. US HWY 224 in Tiffin, Ohio. The form addresses compliance with Executive Order 2022-02D regarding restrictions on expenditure of public funds for services performed by Russian companies or institutions. The document requires the contractor to affirm their business location, service performance locations, and state data storage locations, all of which are currently situated in Tiffin, Ohio.

The form emphasizes prohibitions on purchasing services from Russian entities, in line with Executive Order 2019-12D. The contractor (Tiffin Aire) is agreeing to complete the attached Exhibit II, which incorporates this Affirmation and Disclosure Form as part of any potential contract with the state. The document requires an original signature and includes specific obligations for the contractor to disclose any changes in service locations before, during, and after contract execution, with the state retaining the right to immediately terminate services if such changes occur without proper notification and waiver.