Completed_ODOT_A_D_form.pdf

This document is an Affirmation and Disclosure Form for a contract with the Ohio Department of Transportation (ODOT), specifically addressing compliance with Executive Order 2022-02D regarding services and business operations. The primary contractor is located at 101 West Clearview Ave in Worthington, OH 43085, with two subcontractors identified: David Helton at 2373 Boxwell Rd in Prospect, OH and GKW Business Solutions at 5768 Benthorn Ct in Rockford, MI.

The form explicitly affirms that no services under this contract will be performed by Russian companies or institutions, in alignment with the state's executive order prohibiting the purchase of services from Russian entities. The contractor agrees to complete the attached Exhibit II and discloses that all contract services will be performed at the principal business location in Worthington, OH. The document requires ongoing disclosure of any changes in service locations or subcontractor arrangements, with the state reserving the right to terminate the contract if services are attempted to be performed outside the United States. The form was signed by the company president on 3/22/24, indicating current compliance with state procurement requirements.