101G-26_-_Shelly_Materials_-_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to state contracting requirements, specifically involving Shelly Materials, Inc. and the Ohio Department of Transportation (ODOT). The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions in response to geopolitical circumstances. The document is located in Findlay, Ohio, and pertains to a state contract that requires detailed disclosure of business locations and service performance sites.

The form indicates that Shelly Materials, Inc. will perform contract services at 1700 Fostoria Ave., Ste. 200 in Findlay, OH 45840, with no subcontractors involved. The company affirms it will not use Russian companies or institutions in contract performance and agrees to immediately notify the state of any changes in service locations. The document is signed by Nathan Mathew, VP of Sales, on 2/9/23, and serves as a compliance document ensuring the contractor's adherence to state regulations regarding service procurement and data handling, with specific provisions preventing state data from being sent or processed outside the United States without proper authorization.