OH_CMS_Board_02-29-24_Affirmation_and_Disclosure_Form__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing restrictions on services performed in Russia, as outlined in Executive Order 2022-02D. The form is completed by Lytle Enterprises of OH, LLC, and appears to be associated with the Ohio Department of Transportation (ODOT). The document requires the contractor to disclose key business location details, including the principal business address in Springfield, IL and service performance location in Atlanta, GA.

The form emphasizes compliance with Executive Order 2019-12D, which prohibits state agencies from purchasing offshore services from Russian companies. The contractor affirms that no services will be performed in Russia and agrees to immediately notify the state of any changes in service locations. The document serves as a formal disclosure mechanism requiring the contractor to specify locations where contract services and state data will be managed, with the primary service location listed as 2755 Buker Industrial Drive in Atlanta, GA 30366. The form is dated 02/27/2024 and was signed by a member of Lytle Enterprises, indicating ongoing contractual obligations and compliance with state procurement regulations.