Affirmation___Disclosure__Diamond_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D concerning services performed by Russian companies or institutions. The form is completed by Diamond Stone, located at 3490 US 50 in Albany, OH 45710, and is associated with the Ohio Department of Transportation (ODOT). The document outlines the contractor's principal business location, service performance location, and state data location, all of which are the same address in Albany, Ohio.

The form emphasizes compliance with Executive Order 2022-02D and 2019-12D, which prohibit state agencies from purchasing offshore services from Russia. The contractor affirms that no services will be performed in Russia and agrees to immediately notify the state of any changes in service locations. No specific goods or services are detailed in this document, as it appears to be a standard compliance form ensuring the contractor's adherence to state procurement restrictions related to Russian service providers. The document requires an original signature and is part of the contract award process with the state of Ohio.