Document_250129_164834.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements for contractors performing services under Executive Order 2022-02D. The form is completed by Ohio Machinery Co., located at 3993 E Royalton Rd, Broadview Heights, OH 44147, and is associated with restrictions on services performed in Russia. The document is part of a contract process with ODOT (Ohio Department of Transportation) and adheres to state agency procurement guidelines.

The contractor has indicated that services will be performed "at your location" and has not listed any subcontractors. The form emphasizes compliance with Executive Order 2019-12D, which prohibits offshore services by state agencies and requires immediate disclosure of any changes in service locations. The document is signed by the controller on 1/28/2025, affirming the company's commitment to not perform services in Russia and to notify the state of any potential location changes during the contract period.