Document_241022_104859.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing compliance with Executive Order 2022-02D regarding Russian companies or institutions. The form is completed by Ohio Machinery Co., located at 3993 E. Royalton Rd. in Brecksville Heights, OH 44147, and is associated with the Ohio Department of Transportation (ODOT) contract requirements.

The form indicates that the contractor will perform services at their own location, with no subcontractors listed. The document affirms compliance with restrictions on purchasing services from Russian companies, as outlined in the Executive Order 2019-12D. The contractor agrees to complete an attached Exhibit II, Contractor/Subcontractor Affirmation and Disclosure Form, and commits to immediately notifying the state of any changes in service locations or contract details. The form was signed by the company's Controller on 10/21/2024, demonstrating the company's commitment to the specified contractual and executive order requirements.