scan0001.pdf

This document is an Affirmation and Disclosure Form related to Executive Order 2022-02D, which addresses services performed by Russian companies or institutions. The form is submitted by Mosolutions, with a principal business location at 8225 Esletn Pkwy in Plain City, OH 45064. The document is specifically focused on ensuring compliance with restrictions on services performed in Russia, as outlined in the Executive Order 2019-12D.

The form indicates that no subcontractors will be used, and all services will be performed at the company's primary business address in Plain City, Ohio. The contractor affirms that they will not use public funds for services performed by Russian companies or institutions, and agrees to complete an attached Exhibit II that becomes part of the contract. The form was signed by Neil Locy, Sales Manager, on 5-12-25, certifying the company's commitment to abide by the specified restrictions and regulations regarding service performance and state data location.