Clouse_Construction_-_Affimation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form for Clouse Construction Corp., a contractor for the Ohio Department of Transportation (ODOT), specifically addressing compliance with Executive Order 2022-02D regarding restrictions on services from Russian companies or institutions. The form details the contractor's principal business location in New Riegel, Ohio, and confirms services will be performed in ODOT Districts 1 and 2.

The contract pertains to services that will be performed without the use of subcontractors, with all state data to be located at the contractor's primary business address. The form emphasizes compliance with prohibitions on purchasing services from Russian companies or institutions, as outlined in the Executive Order 2022-02D. The document is signed by the company president, Leonard J. Clouse, on 10-15-2024, affirming the contractor's understanding of the contractual obligations, including potential immediate contract termination if there are changes in service location or performance outside the United States.