1-Scan_Sep_24__2025_at_4.02_PM.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing potential services involving public funds and restrictions on Russian companies. The form is associated with the Ohio Department of Transportation (ODOT) and is being completed by Momar, Inc., a company located at 1830 Ellsworth Industrial Dr NW in Atlanta, GA 30318. The document references Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies and restricts offshore service performance.

The contractor (Momar, Inc.) indicates that services will be performed at 110 Glenn Hwy in Cambridge, OH 43725, with state data to be located at their primary business address in Atlanta, GA. The form requires the contractor to disclose the location of services, affirm no services will be performed in Russia, and commit to immediately notifying the state of any changes in service locations. The document is signed by Chris Raymond, VP of Technical Sales, on 09-24-2025, and serves as a binding disclosure and affirmation as part of any potential contract with the state.