E5_ODOT_AFFIRMATION_DISCLOSEURE_FORM.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and Kenworth of Dayton. The form addresses compliance with Executive Order 2022-02D concerning restrictions on services from Russian companies or institutions. The contractor, located at 7740 Center Point 70 Blvd in Dayton, Ohio 45424, is affirming its commitment to not perform services in Russia and to adhere to the specified executive order restrictions.

The document does not provide specific details about the goods or services under contract. However, it emphasizes that all state agencies are prohibited from purchasing services from Russian companies, and the contractor agrees to complete the attached Exhibit II, which is incorporated as part of the contract. The form requires the contractor to disclose the principal location of business, location where services will be performed, and location where state data will be located. The document was signed by a Fleet Sales Associate on 10/11/2024 at 3:00 pm, indicating an ongoing or future contractual relationship with ODOT.