Affirmation_Signed.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically focused on compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by Mack Industries, Inc., located at 201 Columbia Road in Valley City, Ohio 44280. The document outlines the contractor's commitments and locations for performing services under the contract with the state of Ohio.

The form affirms that Mack Industries will not use Russian companies or subcontractors in performing contract services, in alignment with the state's prohibition on purchasing services from Russian entities. The contractor confirms that all services will be performed at their primary business location in Valley City, Ohio, and that they will immediately notify the state of any changes in service locations or subcontractor arrangements. The document is signed by Glen Diermyer in a Sales role, dated 1/27/25, and serves as a formal disclosure and compliance statement for the state contract.