Affirmation_and_Disclosure_Form_SIGNED_BEC.pdf

This document is an Affirmation and Disclosure Form for a state contract, specifically involving BEC Enterprises LLC (doing business as Brown Equipment) located in Evansville, Indiana. The form is related to an Executive Order addressing restrictions on services from Russian companies or institutions, with the Ohio Department of Transportation (ODOT) being the primary state agency involved. The document outlines the contractor's principal business location at 2501 S Kentucky Ave in Evansville, IN, with service performance location at 4988 Aultman Rd in North Canton, OH.

The form stipulates that the contractor agrees to complete Exhibit II and affirms no services will be performed in Russia. The document highlights restrictions on expenditure of public funds on services performed by Russian companies, stemming from Executive Order 2022-02D. While specific contract details are not fully elaborated, the form serves as a critical compliance document ensuring the contractor's adherence to state regulations regarding offshore services and potential geopolitical restrictions. The form is signed by Kirk Williams, CEO, with a date of 10/01/2024, indicating a future-dated contract or preparation document.