Signed_Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Cincinnati Lift Truck & Battery Service LLC, located in Maineville, Ohio. The form addresses compliance with Executive Order 2022-022, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The contractor affirms that no services under this contract will be performed in Russia, and the company's principal business location is 7685 SR 48 Suite 5 in Maineville, OH 45039.

The form does not specify the exact goods or services under contract, but it requires the contractor to disclose locations where services will be performed, where state data will be located, and commits to notifying the state of any changes in service locations. The document emphasizes compliance with restrictions on offshore services, particularly those related to Russian entities, and requires the contractor to complete an attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form. The form is signed by the company owner, dated 08-20-2024, and serves as a prerequisite for potential contract award and performance.