1-_101L-26_Liquid_Asphalt__Affirmation_and_Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically prepared by Pavement Technology, Inc., located at 24144 Detroit Rd. in Westlake, OH 44145. The form addresses requirements stemming from Executive Order 2022-12D and related state regulations concerning contracts involving Russian companies or institutions, with ODOT (Ohio Department of Transportation) being the primary contracting agency.

The contract involves services to be performed entirely at the company's Westlake, Ohio location, with no subcontractors indicated. The document affirms that no services will be performed in Russia and that the company agrees to immediately disclose any changes in service locations or contractor details. The form is signed by the company's Secretary/Treasurer, acknowledging compliance with state procurement guidelines and restrictions on offshore service provisions, and is dated 3/29/25, suggesting this is part of a formal contractual agreement, potentially related to liquid asphalt procurement or transportation infrastructure services.