scan0016.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by Mosolutions, with the principal business location at 5235 Estates Pkwy in Plan City, OH, and a subcontractor (Volk Manufacturing) located at 66 E Main St, New Kingston, PA. The form is designed to ensure compliance with regulations regarding services performed within and outside the United States.

The form indicates that all services will be performed at the same location as the principal business address, with no services to be performed by Russian companies or institutions. The contractor affirms understanding of prohibitions on purchasing offshore services and agrees to notify the state of any changes in service location. The document was signed by Neil Lewy, Sales Manager, on 6-3-25, and requires full disclosure of any subcontractor involvement and locations where state data may be stored or accessed. The form is part of a broader compliance mechanism to ensure transparency and adherence to state procurement guidelines.