ODOT_062-26_Affirmation_And_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form associated with the Ohio Department of Transportation (ODOT), completed by Wells Group LLC. The form addresses potential services and data management related to a state contract, with specific prohibitions on utilizing Russian companies or institutions as outlined in Executive Order 2022-02D. The contractor's principal business location is listed as 611 W Main St. in West Liberty, Kentucky, and services will be performed in Ohio.

The form indicates that no subcontractors will be used for this contract, and state data will be managed at the primary business address in West Liberty, Kentucky. The document was signed on 3/21/05 by a representative with the title of Ohio Regional Manager, and it affirms compliance with restrictions on offshore services and expenditure of public funds. The contractor agrees to immediate disclosure of any changes in service location and understands that the State reserves the right to terminate the contract if certain conditions are not met.