C-Affirmation_and_Disclosure_61924.docx.pdf

AFFIRMATION AND DISCLOSURE FORM

By the signature affixed hereto, the Contractor affirms and understands that if awarded a contract, both the Contractor and any of its subcontractors shall perform no services requested under this Contract outside of the United States, not allow State data to be sent, taken, accessed, tested, maintained, backed-up, stored or made available remotely(located) outside of the United States unless a duly signed waiver from the State has been attained.

The Contractor shall provide all the name(s) and location(s) where services under this Contract will be performed and where data is located in the spaces provided below or by attachment. Failure to provide this information may result in no award. If the Contractor will not be using subcontractors, indicate “Not Applicable” in the appropriate spaces.

EXPENDITURE OF PUBLIC FUNDS ON SERVICES PERFORMED BY RUSSIAN COMPANIES OR INSTITUTIONS.

The Contractor affirms to have read and understands Executive Order 2022-02D and shall abide by those requirements in the performance of this Contract. Pursuant to this Executive Order, all state agencies are prohibited from the purchase of services from Russian companies or institutions. This prohibition is in addition to and expands upon Executive Order 2019-12D which generally precludes the purchase of offshore services by the State of Ohio. Notwithstanding any other terms of this Contract, ODOT reserves the right to recover any funds paid for services the Contractor performs in Russia in violation of this Executive Order. ODOT does not waive any other rights and remedies provided to ODOT in this Contract.

The Contractor agrees to complete the attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, to abide with Executive Order 2022-02D, which is incorporated and becomes a part of this Contract, affirming no services of the Contractor or its subcontractors under this Contract will be performed in Russia.

1. Principal location of business of Contractor: CBTS

____CBTS Technology Solutions LLC

25 Merchant St. ______ Cincinnati, Ohio 45246___

(Address) (City, State, Zip)

Name/Principal location of business of subcontractor(s):

____CBTS Project Manager __________ _400 Metro Place, Dublin Ohio, 43002___

(Name) (Address, City, State, Zip)

____ CBTS Project Director ____________ _400 Metro Place, Dublin Ohio, 43002 _

2. Location where services will be performed by Contractor: Resultant

111 Monument Cir #202 _ _____ _ Indianapolis, IN 46204 __

Name/Location where services will be performed by subcontractor(s):

_Resultant CCaaS Developer ___ _Columbus, Ohio, 43202 _ ___________

Contact Center Business Consultant/WFO Specialist_ _ Columbus, Ohio, 43202 _____________

3. Location where state data will be located, by Contractor: StarSevenSix

_2550 Corporate Exchange Drive__ _Columbus, Ohio, 43231

DocuSign Envelope ID: EF1D268C-66D9-4D83-8739-5D5F0F462234

Name/Location(s) where state data will be located by subcontractor(s):

_ ServiceNow Developer _ _____ __ Columbus, Ohio, 43231 _____ ___

ServiceNow Certified Technical Architect

__________________________________ __ Columbus, Ohio, 43231 _____ ___

Senior Business Process Consultant Columbus, Ohio, 43231 _________

Contractor also affirms, understands and agrees that Contractor and its subcontractors are under a duty to disclose to the State any change or shift in location of services performed by Contractor or its subcontractors before, during and after execution of any contract with the State. Contractor agrees it shall so notify the State immediately of any such change or shift in location of its services. The State has the right to immediately terminate the contract, unless a duly signed waiver from the State has been attained by the Contractor to perform the services outside the United States.

On behalf of the Contractor, I acknowledge that I am duly authorized to execute this Affirmation and Disclosure Form and have read and understand that this form is a part of any Contract that Contractor may enter into with the State and is incorporated therein.

(AN ORIGINAL SIGNATURE IS REQUIRED)

Company Name: _CBTS Technology Solutions LLC _____________________

Signature: __________________________________

Print Name: __Gene Ratto_ __________________

Title: Sales VP _____________

Date: __6/26/2027_________________________

DocuSign Envelope ID: EF1D268C-66D9-4D83-8739-5D5F0F462234