1-Affirmation_and_Disclosure_Form.pdf

The document is an Affirmation and Disclosure Form for Unique Paving Materials Corp., located at 3993 E 93rd Street in Cleveland, OH 44105. It relates to compliance with Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The form is part of a contract with ODOT (Ohio Department of Transportation) and requires the contractor to affirm that no services will be performed in Russia and that they are not engaging with Russian companies or institutions.

The form indicates that Unique Paving Materials Corp. will perform all contract services at their Cleveland, OH address, with no subcontractors listed. The company, represented by Donald Kautzman in the role of Treasurer, signed the document on 4-4-2025, affirming compliance with the executive order's restrictions on Russian service providers. The form serves as a mandatory disclosure ensuring that any state contract work will be conducted exclusively within the United States and does not involve any Russian entities or offshore services.