Affirmative_and_disclosure_document__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and Southeastern Equipment Company, located at 10874 East Pike Rd in Cambridge, OH 43725. The form addresses restrictions on expenditure of public funds for services performed by Russian companies or institutions, pursuant to Executive Order 2019-12D, which prohibits state agencies from purchasing services from Russian entities.

The form does not specify detailed contract goods or services, but requires the contractor to disclose locations of business, service performance, and state data storage. No subcontractors are listed, and all entries for subcontractor information are marked "N/A". The document emphasizes the contractor's obligation to immediately notify the state of any changes in service locations or contract conditions, with the understanding that the state retains the right to terminate the contract if services are performed outside the United States. The form was signed by Chris Kurz, Regional Sales Manager, on September 24, 2024, and serves as a mandatory disclosure and affirmation document for contract participation.