Holmes_Supply_Affirmation___Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Holmes Supply Corp from Holmesville, OH 44633. The form is associated with the Ohio Department of Transportation (ODOT) and addresses requirements outlined in Executive Order 2022-02D concerning services performed by Russian companies or institutions. The document requires the contractor to disclose the location of business, services, and state data, with Holmes Supply Corp listed as the primary contractor and no subcontractors noted.

The form indicates that Holmes Supply Corp will perform services at 7571 State Route 83 in Holmesville, OH 44633, with all state data to be located at the same address. The contractor affirms compliance with prohibitions on purchasing services from Russian companies or institutions, as specified in the Executive Order 2019-12D. The document is a tax certification (W-9 form) for Holmes Supply Corp, which is registered as a C Corporation, and includes the company's Employer Identification Number 31-1496267. The form was signed by the Vice President of Operations on 02-27-25, signifying the company's agreement to the contract's terms and conditions.