Signed_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form for a contract with the state, specifically involving Southeastern Equipment located in Cambridge, Ohio. The form is designed to comply with Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The contractor, based at 10874 East Pike Road in Cambridge, OH 43725, is affirming their compliance with regulations regarding offshore services and potential contract restrictions.

The form indicates that the contractor (Southeastern Equipment) has no subcontractors listed and has not specified a specific location where services will be performed. The document emphasizes the contractor's agreement to abide by Executive Order 2022-02D, which restricts purchasing services from Russian entities. While the specific goods or services are not detailed in this form, the document serves as a critical compliance mechanism for state contracting, ensuring that vendors are not conducting business with Russian companies and are transparent about their business locations and potential service performance areas.