1-Affirmation_and_Disclosure-_FPO_Signed_6-17-25.pdf

This document is an Affirmation and Disclosure Form for a contract involving Flexible Pavements of Ohio, with primary business location at 6205 Emerald Parkway, Suite B in Dublin, OH 43016. The form relates to Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions in response to the ongoing conflict in Ukraine. The document involves the Ohio Department of Transportation (ODOT) and includes provisions for a subcontractor, Larry Shively, located at 15050 Twp. Rd. 412 in Thornville, OH 43076.

The services will be performed at the Ohio University Lancaster Campus, specifically in Herrold Hall, Room 102 in Lancaster, OH 43130. The contract includes provisions for data handling, with both the primary contractor and subcontractor required to disclose locations where state data will be stored or accessed. The document emphasizes compliance with the executive order prohibiting expenditure of public funds on services performed by Russian companies or institutions, with ODOT reserving the right to recover funds paid for any services in violation of these terms. The form is signed by the Executive Director, indicating the company's commitment to these contractual obligations.