1-AFFIRMATION_AND_DISCLOSURE_FORM.pdf

This document is an Affirmation and Disclosure Form for Pine Tree Towing & Recovery, Inc., located at 1497 E. Pike Rd in Cambridge, OH 43725. The form is related to a state contract and complies with Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The contractor affirms understanding and agreement to abide by the requirements, including restrictions on performing services in Russia and potential contract termination if service locations change.

The contractor indicates services will be performed in Zone: 5C, 10A, 5B, 11A, 11B, with all state data to be located at the company's primary business address. No subcontractors are listed on the form. The document emphasizes the contractor's commitment to immediately disclose any changes in service locations and acknowledges the state's right to terminate the contract if services are performed outside the United States. The form was signed by Christopher Myers, President of Pine Tree Towing & Recovery, Inc., on 4/24/2025, affirming the company's compliance with the specified contractual and executive order requirements.