Affirmative_and_disclosure_form_-_signed_-_1-28-25__1_.pdf

This document is an Affirmation and Disclosure Form related to a contract with the Ohio Department of Transportation (ODOT), specifically addressing restrictions on services performed by Russian companies or institutions. The form is completed by Southeastern Equipment Co., located at 11884 East Pike Rd in Cambridge, OH 43725, and is associated with Executive Order 2019-12D, which prohibits state agencies from purchasing services from Russian companies.

The form does not specify the exact goods or services under contract, but it requires the contractor to affirm that no services will be performed in Russia and that they will complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form. The document emphasizes compliance with state regulations regarding the prohibition of services from Russian companies or institutions, with the contractor agreeing to immediately notify the state of any changes in location or service provisions. The form is signed by Chris King, Regional Sales Manager, on January 28, 2025, and is part of a contractual agreement with ODOT.