ODOT_Affermation_and_Disclosure_Form__1_.pdf

This document is an Affirmation and Disclosure Form related to a contract involving the Ohio Department of Transportation (ODOT) and Site Safe, LLC. The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The contractor, based in Leithfield, KY, has provided its principal business location and service performance location as 200 Jorge Kenneth H. Goff Dr. and 1500 Obetz Rd. in Columbus, OH, respectively.

The form stipulates that the contractor will not perform any services in Russia and agrees to abide by the executive order's requirements. The document requires disclosure of any potential changes in service locations and gives the state the right to immediately terminate the contract if the contractor fails to comply. The form is signed by Leo Pepas, a Sales Representative of Site Safe, LLC, on 11-21-24, affirming the company's commitment to not engaging with Russian entities and understanding the terms of the contract with ODOT.