AFFIRMATION_AND_DISCLOSURE_FORM_final.pdf

This document is an Affirmation and Disclosure Form for Tiffin Aire, located at 1778 W. US HWY 224 in Tiffin, Ohio 44883. The form relates to compliance with Executive Order 2022-02D, which addresses restrictions on expenditure of public funds for services performed by Russian companies or institutions. The document requires the contractor to affirm their location of business, service performance, and state data storage, all of which are listed as being in Tiffin, Ohio.

The form specifically addresses prohibitions on purchasing services from Russian entities, in line with the Executive Order 2019-12D. The contractor agrees to complete Exhibit II, which is incorporated into any potential contract with the state, and affirms that no services under this contract will be performed in Russia. The document requires full disclosure of business locations and serves as a mandatory compliance document for state contracts, ensuring transparency about service locations and adherence to current executive restrictions on international service procurement.