Affirmation___Disclosure_Form_-_OCTANE.pdf

This document is an Affirmation and Disclosure Form related to an Executive Order 2022-02D, which addresses services performed by contractors in Russia. The form is completed by OCTANE Forklifts Inc., located at 4905 Lima Street in Denver, CO 80239, and is associated with a state contract that prohibits the expenditure of public funds on services performed by Russian companies or institutions. The document pertains to potential contract work and requires disclosure of service locations and any subcontractors.

The contractor, OCTANE Forklifts Inc., indicates that no subcontractors will be utilized for this contract, and all services will be performed at their Denver, Colorado address. The form specifically addresses compliance with an Executive Order that restricts state agencies from purchasing offshore services from Russia, with the contractor affirming that they will not perform any services in Russia in violation of the order. The document requires the company to complete an attached Exhibit II and provides the State with the right to immediately terminate the contract if the contractor changes service locations without proper notification.