Ukraine_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form completed by a contractor, with the primary business location at 7292 Cascade Dr in West Chester, OH 45069. The form addresses compliance with Executive Orders regarding offshore services, data location, and purchasing restrictions. The contractor indicates no subcontractors will be used for this contract, and the services will be performed at 3791 OH-63 in Lebanon, OH 45036.

The form requires the contractor to disclose locations where services will be performed and where state data will be located. The contractor affirms an understanding and agreement to immediately notify the state of any changes in service locations before, during, or after contract execution. The document was signed by Yahya A. Hansbhai, an intern, on 6/22/2025, and serves as a standard compliance document that will be incorporated into any potential contract with the state. No specific details about the goods or services are provided in this disclosure form.