Affirmation_and_Disclosure_Form_-_Final.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing services and potential performance under Executive Order 2022-02D concerning Russian companies. The form is completed by Southeastern Equipment Company, located at 10874 East Pike Rd in Cambridge, OH 43725, and is designed to ensure compliance with state regulations regarding contract performance, particularly restrictions on services performed in Russia.

The form indicates that the contractor agrees to complete an attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, and affirms that no services will be performed in Russia under this contract. The document highlights restrictions stemming from Executive Order 2022-02D, which prohibits state agencies from purchasing offshore services and requires disclosure of service locations. No specific subcontractors are listed, and the locations for service performance are marked as "N/A". The form was signed by the Regional Sales Manager on October 23, 2024, and becomes part of any contract entered into with the state, emphasizing the contractor's commitment to compliance with state procurement guidelines.