ODOT_2024_AFFIRMATION___DISCLOSURE_PAGE_2.pdf

This document is an Affirmation and Disclosure Form for a state contract, signed by Ryan Horsley in his capacity as Operations Manager on December 11, 2023. The form requires the contractor to disclose any shifts in location of services and affirms the contractor's obligation to notify the State immediately of any changes. The document provides placeholder spaces for multiple contractor names and addresses, indicating it is a standardized template for state contract participation.

The form outlines critical contractual obligations, specifically that the contractor and its subcontractors are required to perform services under the contract and immediately report any changes in service location. The State retains the right to terminate the contract unless a signed waiver is provided. By signing, the contractor acknowledges authorization to execute the form and understands it is incorporated as part of the broader contract with the State. While specific contract details are not present in this document, it serves as a formal administrative precursor to a state contract agreement.