1-OH_DOT_Affirmation_and_Disclosure_Final_5.27.25.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and Henderson Products, Inc. The form addresses compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions, and requires detailed disclosure of business locations and service performance sites. The contractor, Henderson Products, Inc., is based in Manchester, Iowa, with a service location in Bucyrus, Ohio.

The contract involves the potential performance of services, with the primary business location at 1085 S. 3rd St. in Manchester, IA 52057 and the service performance location at 2177 State Route 19 in Bucyrus, OH 44820. No subcontractors are indicated on the form. The document emphasizes the contractor's obligation to disclose any changes in service locations and affirms compliance with restrictions on offshore services by Russian entities. The form is signed by Kathleen Weber, Contract Administrator, with a date of 4/30/2025, indicating a contract or agreement period that extends to that date.