affirmation___disclosure_form_2025.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on expenditure of public funds for services performed by Russian companies or institutions. The form involves Millers Dewing Inc. as the primary contractor, with the document tied to an Executive Order 2022-02D that prohibits state agencies from purchasing services from Russian companies. The contractor is affirming compliance with these restrictions and providing details about their principal business location and service performance locations.

The form indicates that the contractor's principal business location and service performance location is at 208 West Waterloo Road, with a zip code of 44315. The document requires disclosure of any subcontractors and locations where services will be performed, with the contractor explicitly stating they will not perform services in Russia. The form is part of a broader compliance mechanism related to state procurement restrictions, requiring the contractor to affirm no services will be conducted in Russia and acknowledging potential contract termination if these conditions are violated.