101G-26_Affirmation___Disclosure_Form__3_.pdf

This document is an Affirmation and Disclosure Form related to an Ohio Department of Transportation (ODOT) contract, specifically addressing requirements under Executive Order 2022-02D. The form is completed by A & B Asphalt Corp, with Chris Dittus, Vice President, signing on behalf of the company. The document emphasizes compliance with regulations regarding services performed by Russian companies or institutions, particularly in light of geopolitical restrictions.

The form indicates that the contractor affirms they will not perform services in Russia or use subcontractors located in Russia, in accordance with the Executive Order. All sections related to specific locations of business, service performance, and data storage are marked "Not Applicable," suggesting the contractor does not have operations in Russia. The document requires the contractor to immediately disclose any changes in service locations to the State, with ODOT reserving the right to terminate the contract if such changes occur without proper notification or waiver.