02202025_AFFIRMATION_AND_DISCLOSURE_FORM.pdf

This document is an Affirmation and Disclosure Form from Holmes Supply Corp, located in Holmesville, OH, related to a contract with the Ohio Department of Transportation (ODOT). The form addresses requirements stemming from Executive Order 2022-02D concerning services performed by Russian companies or institutions, affirming that the contractor will not use subcontractors to perform services in this Contract within Russia.

The form specifies that Holmes Supply Corp will perform all services at its primary business location at 7571 State Route 83 in Holmesville, OH 44633. No subcontractors are indicated as being part of this contract. The document emphasizes compliance with prohibitions on purchasing services from Russian companies or institutions, with ODOT reserving the right to recover any funds paid for services under this contract. The form was signed by Bruce St. Clair, Vice President of Operations, on 02-26-25, and is accompanied by a W-9 tax form for the company.