affirmation___DIsclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements for contractors performing services outside the United States. The form involves Alta Equipment Company, located in Oakwood Village, Ohio, with Midwest Mine Services listed as a subcontractor. The document is associated with the Ohio Department of Transportation (ODOT) and references Executive Order 2022-02D concerning restrictions on services performed by Russian companies or in Russia.

The form outlines the principal business location at 181 Oak Leaf Oval in Oakwood Village, Ohio, with services to be performed at the same address. Midwest Mine Services, located at 5050 Nike Drive in Hillard, Ohio, is identified as a subcontractor. The document emphasizes compliance with Executive Order 2019-12D, which generally prohibits offshore services by the State of Ohio. State data will be located with Alta Equipment Company at 181 Oakleaf Oval. The form requires the contractor to affirm no services will be performed in Russia, and mandates immediate disclosure of any changes in service locations or subcontractor arrangements.