Affirmation_and_Disclosure_signed__1_.pdf

This document is an Affirmation and Disclosure Form related to a contract involving the Ohio Department of Transportation (ODOT) and a contractor located at 127 N. Walnut Street in Lindendwood, IL 61049. The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions in response to the conflict in Ukraine. The contractor affirms their commitment to these restrictions and provides details about their business location and service performance.

The form indicates that the contractor will perform services at their primary business address in Lindendwood, IL, with no subcontractors listed. The document emphasizes the contractor's obligation to immediately notify the state of any changes in service location or potential violations of the executive order. While specific contract details are not fully elaborated, the form represents a formal acknowledgment of compliance with state procurement restrictions related to Russian entities, with the contractor signing on April 3, 2024, in the role of Government Sales Coordinator.