Affirmation_and_Disclosure_ODOT_309A.25_completed.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Underground Utilities Inc. and the Ohio Department of Transportation (ODOT). The form addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions. The contractor, located at 416 W. Monroe St. in Monroeville, OH 44847, is affirming its commitment to not perform any services in Russia and to abide by the specified executive order restrictions.

The document outlines the contractor's principal business location, service performance locations, and state data storage sites, all of which are situated in Monroeville, Ohio. The form emphasizes that no services will be performed in Russia, and the contractor agrees to immediately disclose any changes in service locations or potential shifts in operations. The document is signed by John A. Bores, Vice President of Underground Utilities Inc., on January 30, 2025, and serves as a formal declaration of the company's compliance with state procurement guidelines and sanctions-related restrictions.