101G-26_Affirmation_Page_CAC.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically issued by the Ohio Department of Transportation (ODOT) under Executive Order 2022-02D. The form is completed by Canton Asphalt Co., located in N. Canton, Ohio, with its principal business address at 5947 Whipple Ave NW and service location at 3467 River Zear Rd in Bolivar, OH.

The form addresses compliance with regulations regarding the expenditure of public funds, particularly focusing on restrictions related to services performed by Russian companies or institutions. The contractor affirms that no services will be performed by Russian entities and agrees to immediate contract termination if such a situation arises. The document serves as a formal declaration of the contractor's business locations, service performance sites, and commitment to adhering to state contract requirements, with the Vice President Scott E. Oster signing the document on 2-25-05.