Affirmation_and_Disclosure__1___3_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically for Montage Enterprises. The form is associated with the Ohio Department of Transportation (ODOT) and addresses requirements outlined in Executive Order 2022-02D regarding Russian companies and services. The primary contractor is Montage Enterprises, located in Blairstown, NJ, with two subcontractors: Steinke Tractor from Eaton, OH and Vernon Dell Tractor from Liverpool, OH.

The document details the locations where services will be performed, with Vernon Dell Tractor listing service locations in Carlton, OH and Grove City, OH. The form emphasizes compliance with state regulations, particularly prohibitions on using Russian companies or performing services in Russia. The contractor agrees to complete an attached Exhibit II and affirms that no services will be performed in Russia. The document was signed by the Vice President on 07-02-24, acknowledging the terms and conditions of the contract, including the obligation to disclose any changes in service locations or potential shifts in service performance.