Affirmation_and_Disclosure__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements under Executive Order 2022-02D concerning services performed by Russian companies or institutions. The form is completed by Pahl Ready Mix Concrete, Inc., located in Bryan, OH, and is designed to provide transparency about the contractor's business location, service performance areas, and data storage locations.

The contractor indicates that services will be performed in various locations, with the primary business address at 14586 US 127 EW in Bryan, OH. The form notes that no subcontractors will be used for this contract, and the state data will be located at the same business address. The document is part of a contract process that prohibits the use of offshore services by the State of Ohio and requires disclosure of any potential violations of the Executive Order. The form is signed by the General Manager, Justin Votaw, with an execution date of 4/10/2025, affirming the company's compliance with the specified contractual and legal requirements.