Affirmation_and_Disclosure_Signed.pdf

This document is an Affirmation and Disclosure Form for a contract involving Kenworth of Richfield, located in Richfield, Ohio, with a subcontractor named Fontaine Modification. The form is related to Executive Order 2022-02D and addresses compliance with regulations regarding services performed by Russian companies or institutions. The primary contractor and subcontractor are based in Ohio, with Fontaine Modification having additional locations in Chillicothe, OH and Charlotte, NC.

The contract involves services to be performed at 2890 Brecksville Rd in Richfield, OH, with state data to be located at the same address and at Fontaine Modification's addresses in Chillicothe and Charlotte. The document affirms that no services will be performed in Russia, in compliance with the Executive Order, and that the contractor agrees to disclose any changes in service locations before, during, and after contract execution. The form is signed by Jeff Reutter, New Truck Sales Manager, on 10/01/2024, indicating a current or upcoming contractual arrangement.