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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 Outstanding Health LLC, located at 470 W. Broad St. in Columbus, OH, and addresses compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The contractor affirms understanding of the executive order's requirements and restrictions on offshore services.

The form indicates that the services will be performed at 71 Southbound Mile Marker in Wilmington, OH, with the contractor's primary business location and state data storage located at the Columbus address. The document emphasizes the contractor's commitment to not using subcontractors for services under this contract and requires immediate disclosure of any changes in service locations before, during, or after contract execution. The form was signed by Walter Watts, the owner of Outstanding Health LLC, on January 27, 2025, certifying compliance with the specified contractual and executive order requirements.