Ohio_DOT.pdf

This document is an Affirmation and Disclosure Form related to the Ohio Department of Transportation (ODOT) contract, specifically addressing compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by a contractor with a principal business location at 405 N Jefferson in Springfield, MO 65806, and is designed to ensure adherence to state regulations prohibiting business with Russian entities.

The form emphasizes that the contractor is prohibited from performing any services in Russia and must disclose the locations where contract services will be performed. The document requires the contractor to affirm understanding of Executive Order 2022-02D and 2019-12D, which generally preclude the purchase of offshore services by the State of Ohio. By completing this form, the contractor certifies 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 or contract conditions. The form is part of a broader compliance mechanism to restrict state business interactions with Russian companies.