AFFIRMATION_AND_DISCLOSURE__10_.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D regarding services performed by Russian companies or institutions. The form is completed by Construction Equipment Crossley Supply, located at 3015 Old Railroad Road in Smyrsky, OH 44870. The document is part of a contract with the Ohio Department of Transportation (ODOT) and requires the contractor to affirm that no services will be performed in Russia or by Russian subcontractors.

The form details the principal location of business, service performance locations, and state data storage locations, all of which are within the United States. No subcontractors are listed, and the company indicates it will perform services at its primary business address. The document includes a certification that the company understands its obligation to disclose any changes in service locations and agrees to comply with state regulations prohibiting offshore services. The form was signed by Jordan Wagner, Vice President, on 1/6/25, and is intended to be incorporated as part of any future contract with the state of Ohio.