OHDOT_Affirmation_and_Disclosure_Form_3.17.25.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 completed by Galion Goodwin Truck Body, LLC, located in Dundee, OH, and is designed to affirm the contractor's compliance with Executive Order 2022-02D regarding offshore services and Russian company restrictions. The document outlines the contractor's principal business location, service performance location, and state data storage location, all of which are at 7415 Peabody Kent Rd in Dundee, OH 44624.

The form indicates that Galion Goodwin Truck Body, LLC will perform services directly, with no subcontractors involved, and affirms that they will not use Russian companies or institutions in the contract's execution. 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 offshore services are used without a signed waiver. The document was signed by Kristie Stockman, National Sales Manager, on 3/17/25, representing the company's commitment to the contract's terms and conditions.