AFFIRMATION_AND_DISCLOSURE_-_NATIONAL_SHOTCRETE_LLC_DBA_NATIONAL_GUNITE.pdf

This document is an Affirmation and Disclosure Form for a contract with the Ohio Department of Transportation (ODOT), completed by National Shotcrete LLC (doing business as National Gunite). The form specifically addresses compliance with Executive Order 2022-022, which prohibits the expenditure of public funds on services performed by Russian companies or institutions in response to the geopolitical situation. The contractor affirms that services will be performed primarily at 111 Roosevelt Blvd in Johnston, PA, and within Ohio DOT Districts 1 through 12.

The contract requires the contractor to provide all necessary services under the terms of the agreement, with a strict prohibition on using Russian subcontractors or performing any services in Russia. The document indicates that the contractor (represented by Michael W. Prucinsky in the role of Treasurer) agrees to complete an attached Exhibit II, ContractorSubcontractor Affirmation and Disclosure Form, and acknowledges ODOT's right to recover any funds paid for services if there is a violation of the executive order. The form was signed on 2/18/25, suggesting a current or near-future contract period with ODOT.