Affirmation_Disclosure11052024__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically focused on compliance with Executive Order 2022-02D. The form is completed by Key Cable and Supply, located at 4037 Genoa Rd in Perrysburg, Ohio 43551. The document pertains to restrictions on services performed by Russian companies or institutions, as mandated by Ohio state regulations and federal executive orders.

The form details the contractor's principal business location, service performance locations, and state data storage sites, all of which are situated in Perrysburg, Ohio. The contractor affirms that no services will be performed by Russian companies or subcontractors, and acknowledges ODOT's (Ohio Department of Transportation) prohibition on purchasing services from Russian entities, particularly in the context of the Executive Order 2019-120. The form requires the contractor to disclose any changes in service locations and gives the state the right to terminate the contract if services are attempted to be performed outside the United States.