MM-AFFIRMATION_AND_DISCLOSURE_FORM.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically for the Ohio Department of Transportation (ODOT). The form is completed by Martin Marietta, with the principal business location at 9244 Centre Pointe Drive in West Chester, Ohio. The document addresses compliance with Executive Order restrictions on services performed by Russian companies or institutions, particularly in the context of state contracts.

The form requires the contractor to disclose the location of services under the contract, with the principal location and subcontractor information specified. It emphasizes compliance with prohibitions on purchasing services from Russian companies or institutions, as outlined in the Executive Order for the State of Ohio. The contractor, Gabriel Stephens (Associate Sales Representative), affirms understanding of the contractual obligations, including the requirement to immediately disclose any changes in service locations and the potential for contract termination if services are performed in Russia without a signed waiver from the state.