Affirmation_and_Disclosure_Form_007-25_Contract_-_Maverick.pdf

This document is an Affirmation and Disclosure Form related to an Ohio Department of Transportation (ODOT) contract, specifically executed by Maverick Environmental Equipment LLC located in Ashtabula, Ohio. The form addresses requirements under Executive Order 2022-02D, focusing on restrictions for services performed by Russian companies or institutions, and requires the contractor to disclose key location and service performance details.

The contract involves Maverick Environmental Equipment LLC, with its principal business location and service performance location at 3901 N. Bend Rd. in Ashtabula, OH 44004. The document includes a subcontractor, Maverick Environmental - OH South, located at 615 Logan-Thornville Rd. NE in Bremen, OH 43107. The form specifically emphasizes that no services will be performed in Russia, and the contractor agrees to immediately disclose any changes in location or services before, during, and after contract execution. The document is signed by the Managing Partner on 12-26-24, indicating the contract's contemporary nature and compliance with state-level regulatory requirements.