DOC022025-02202025082430.pdf

This document is an Affirmation and Disclosure Form for Bucyrus Road Materials, Inc., located in Bucyrus, Ohio, pertaining to a state contract governed by Executive Order 2022-02D. The form addresses compliance requirements related to services performed, with specific emphasis on restrictions concerning Russian companies and institutions in the context of state contract work.

The form details the contractor's principal business location at 1407 Tiffin Road in Bucyrus, Ohio, and affirms that all services will be performed at the same address. The document explicitly states that the contractor agrees to abide by Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies, and confirms that no services under this contract will be performed in Russia. The contractor has completed this form as part of a contractual agreement, demonstrating compliance with state procurement regulations and geographic service restrictions.