Complete_Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is completed by a contractor located at 701 N Westwood Ave in Toledo, Ohio, with the signatory being Matthew Zimmerman, Vice President. The document addresses compliance with Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions in response to the geopolitical context of the time.

The form confirms that the contractor will perform services at the same Toledo, Ohio address, with no subcontractors involved. The document explicitly affirms that no services under this contract will be performed in Russia, in alignment with the executive order. The contractor agrees to immediate contract termination by the State if there are any changes in the location of services or shift in contract performance that would violate the terms of the executive order. The form serves as a formal affirmation of the contractor's commitment to these conditions and provides key location and contact details for the business entity entering into the contract with the state of Ohio.