Affirmation.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and a contractor located in Waynesburg, Ohio. The form addresses requirements under Executive Order 2022-02D, which prohibits the expenditure of public funds on services performed by Russian companies or institutions. The contractor is affirming compliance with these regulations and providing details about their business location and potential service performance.

The form indicates that the contractor's principal business location is at 12288 County Road M in Waynesburg, Ohio 43567, and the location of services will be determined. No subcontractors are listed as applicable. The document references an attached Exhibit II (Contractor/Subcontractor Affirmation and Disclosure Form) and emphasizes the contractor's agreement to abide by the Executive Order, which precludes purchasing offshore services from Russian companies. The form was signed by the contractor's treasurer on 12/13/23, formally attesting to the disclosed information and contractual obligations.