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This document is an Affirmation and Disclosure Form related to the Ohio Department of Transportation (ODOT) contract requirements, specifically addressing restrictions on services performed by Russian companies or institutions. The form is tied to Executive Order 2022-02D, which prohibits state agencies from purchasing offshore services. The contractor, Mosolutions, is completing this form to affirm compliance with state regulations regarding service locations and potential subcontractors.

The form confirms that all contract services will be performed at 8235 Esters Pkwy in Plain City, OH 43064, with no subcontractors involved. The contractor agrees to immediately disclose any changes in service locations and understands that the contract could be terminated if services are performed outside the United States. The document was signed by Neil Lacy in the role of Seller on 7-7-23, affirming that no services will be conducted in Russia and that the company will comply with all relevant state procurement restrictions and executive order requirements.