ODOT_213-24_Signature_Page__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is aligned with Executive Order 2022-02D and concerns restrictions on services performed by Russian companies or institutions. The contractor's principal business location is at 2550 W 5th Ave in Columbus, Ohio, with a zip code of 43204.

The form emphasizes compliance with executive orders prohibiting state agencies from purchasing services from Russian companies or institutions. It requires the contractor to disclose locations where services will be performed and where data will be located. The contractor affirms that no services under this contract will be performed in Russia, and they agree to immediately notify the State of any changes in service locations. The document serves as a mandatory disclosure and affirmation mechanism to ensure transparency and adherence to state-mandated restrictions on international service procurement.