1-3995_001_3.pdf

This document is an Affirmation and Disclosure Form related to a contract with the Ohio Department of Transportation (ODOT), specifically for ODOT district 9. The contractor is M P Dory Co., located at 2001 Integrity Drive South in Columbus, Ohio. The form is designed to disclose information about contract performance locations, adherence to Executive Order 2022-02D regarding Russian companies, and potential subcontractors.

The document indicates that the contractor will not perform any services outside the United States and has no current subcontractors listed. The contractor agrees to comply with restrictions on services from Russian companies and institutions, as outlined in the Executive Order. The form requires disclosure of business locations, service performance locations, and data storage locations, all of which are currently specified as 2001 Integrity Drive South in Columbus, Ohio. The document is signed by a consultant named Bob Park on 07/30/2025, with an original signature required as part of the contract documentation.