Affirmative_and_disclosure_form_-_signed.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 Co. The form addresses requirements for contractors performing services, with particular emphasis on restrictions related to Russian companies or institutions, in accordance with Executive Order 2019-12D. The form requires detailed disclosure of the contractor's principal business location, which is listed as 10884 East Pike Rd in Cambridge, OH 43725.

The document focuses on ensuring compliance with state data handling regulations, particularly concerning services performed outside the United States. The contractor (Southeastern Equipment Co.) affirms that they will not allow state data to be sent, accessed, or stored outside the United States without a signed waiver. The form also incorporates provisions of Executive Order 2019-12D, which prohibits state agencies from purchasing services from Russian companies or institutions. The contractor agrees to complete an attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, and confirms that no services will be performed in Russia under this contract.