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This document is an Affirmation and Disclosure Form for Strawser Construction Inc./DBA Terry Asphalt Materials Inc., located at 1392 Dublin Rd. in Columbus, Ohio 43215. The form is associated with an Executive Order 2022-02D concerning the expenditure of public funds on services performed by Russian companies or institutions, and relates to potential contract services with the State of Ohio. The document requires detailed disclosure about the contractor's business locations, service performance locations, and state data storage locations.

The form indicates that no subcontractors are currently planned for this contract, and the company affirms it will not perform services outside the United States unless specifically authorized. The contractor agrees to notify the State immediately of any changes in service locations and understands the restrictions on using public funds for services related to Russian companies, as outlined in the referenced Executive Order. The document was signed on 4/7/2025 by David Rise in the role of Technical Sales & Business Development, signifying the company's commitment to compliance with the state contract requirements.