1-affirmation_form.pdf

This document is an Affirmation and Disclosure Form related to an Ohio Department of Transportation (ODOT) contract, completed by K-Tech Specialty Coatings, located in Ashley, Indiana. The form addresses compliance with Executive Order 2022-02D, specifically focusing on restrictions regarding Russian companies and institutions in light of geopolitical circumstances. The contractor affirms understanding and agreement to the terms, including prohibitions on services performed by Russian entities.

The document details the contractor's principal business location, service performance location, and state data location, all situated at 111 W Garfield St and 3230 W 800 S in Ashley, IN 46705. No subcontractors are listed. The form emphasizes the contractor's commitment to not performing services for the contract in Russia, adhering to the Executive Order's requirements, and understanding that ODOT reserves the right to recover funds and terminate the contract if these conditions are not met. The form is signed by the COO with an execution date of 9/24/2025, indicating this is part of a future contract preparation process.