Affirmation_and_Disclosure__2_.pdf

This document is an Affirmation and Disclosure Form related to Executive Order 2022-02D, which prohibits expenditure of public funds on services performed by Russian companies or institutions. The form is completed by M&B Asphalt Co., Inc., a contractor providing services, with its principal business location at 1525 CR 42 in Tiffin, OH 44883. The document is designed to ensure compliance with state and federal regulations regarding services performed outside the United States.

The form confirms that M&B Asphalt Co., Inc. will perform all contracted services at its primary business address in Tiffin, Ohio, with no subcontractors involved. The contractor affirms that it will not conduct any services in Russia and agrees to abide by the restrictions outlined in Executive Order 2022-02D, which expands upon previous Executive Order 2019-12D concerning offshore services. The document serves as a formal declaration that the company will not engage with Russian companies or institutions and understands the potential consequences of contract termination if these terms are violated.