Affirmation_and_Disclosure_signed.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services and procurement involving Russian companies. The form is completed by Cognitive Systems Engineering, Inc., with a principal business location at 7497 Calhoun Rd in Ostrander, OH 43061. The document references Executive Order 2022-020D, which prohibits state agencies from purchasing services from Russian companies or institutions, and extends to offshore services by Ohio state contractors.

The contractor affirms that all services will be performed at the stated business address in Ostrander, OH, with no subcontractors listed. The form requires the contractor to disclose any changes in service locations before, during, and after contract execution, with the state retaining the right to immediately terminate the contract if services are not performed within the United States. The document includes provisions for maintaining and protecting state data, with the signatory (Philip J. Smith, President) acknowledging authorization to execute the form and understanding the contract terms.