1-AFFIRMATION_AND_DISCLOSURE_FORM.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and an Executive Order 2022-02D concerning services performed outside the United States. The form is completed by Natural Own Source LLC, located in Brecksville, OH, and is designed to affirm the contractor's compliance with specific contractual and governmental requirements.

The document indicates that the contractor will perform services at 344 N. Cleveland Ave. in Mandore, OH, with no subcontractors listed. The form emphasizes compliance with Executive Order 2022-02D, which prohibits the purchase of services from Russian companies or institutions due to the ongoing geopolitical situation. The contractor affirms that no services under this contract will be performed in Russia, and the company is obligated to disclose any changes in service locations or subcontractor arrangements. The form was signed by the company's President/Sole Member on 9/14/2025, confirming understanding and agreement to the specified terms and conditions.