adf_odot_2025.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT). The form is completed by Mortz Concrete Inc., located at 368 N Trimble Rd. in Mansfield, OH 44901. The document is designed to ensure compliance with Executive Order 2022-02D, which addresses restrictions on engaging with Russian companies or institutions in the context of state contracts.

The form requires the contractor to disclose key information about their business operations, including the principal location of business and potential service locations. A critical aspect of the document is the explicit prohibition on expending public funds on services performed by Russian companies or institutions, with specific implications for ODOT contracts. The contractor affirms understanding and agreement to abide by these restrictions, acknowledging that failure to comply could result in contract termination. The document was signed by a VP of Mortz Concrete Inc. on 3-25-25, indicating the company's commitment to the specified contractual terms and geographical service restrictions.