ODOT_A_D__3_.pdf

This document is an Affirmation and Disclosure Form for a contract involving Madison Tree & Landscape Co., located in West Jefferson, Ohio. The form is associated with the Ohio Department of Transportation (ODOT) and specifically addresses compliance with Executive Order 2022-02D regarding restrictions on services performed by Russian companies or institutions.

The form outlines the contractor's principal business location at 3180 Glade Run Road in West Jefferson, OH, with service locations listed as "Various". The document emphasizes compliance with prohibitions on purchasing services from Russian companies or institutions, as mandated by the executive order. The contractor agrees to abide by these restrictions and acknowledges that ODOT retains the right to terminate the contract if there are violations. The form was signed by the CEO on 10/9/2024, affirming the company's commitment to these terms and conditions.