Affirmation_and_Disclosure__1_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically executed by Maple Grove Quarry Inc. The form is associated with Executive Order 2022-02D and pertains to restrictions on expenditure of public funds on services performed by Russian companies or institutions. The contractor is based in Tiffin, Ohio, with a principal business location at 1525 W. County Rd. 42, and the document requires disclosure of service locations and potential subcontractors.

The form indicates that Maple Grove Quarry Inc. will perform services at its primary business address in Tiffin, Ohio, and confirms that no services will be performed in Russia. The contractor agrees to notify the State immediately of any changes in service locations or subcontractors. The document is signed by Kevin Morgan, Vice President, on 02/18/2025, and is part of a contractual process that prohibits offshore services by the State of Ohio and requires comprehensive transparency about service performance locations and potential subcontractors.