ODOT_affirmation_and_diclosure_signed_101g02122025.pdf

This document is an Affirmation and Disclosure Form for Mid-Ohio Paving Inc., located at 6095 Columbus Rd in Centerburg, Ohio 43011. The form is associated with the Ohio Department of Transportation (ODOT) and addresses compliance with Executive Order 2022-02D regarding restrictions on services performed by Russian companies or institutions. The contractor affirms that all services will be performed within the United States, specifically at their Centerburg, Ohio location, and agrees to abide by the state's requirements concerning offshore services.

The document does not specify the exact goods or services under contract, but it emphasizes the contractor's commitment to not performing any services in Russia and complying with state procurement restrictions. The form requires the contractor to disclose any changes in service locations and gives the state the right to immediately terminate the contract if these conditions are not met. The document is signed by the company's president and dated 2-12-2025, suggesting a contract or agreement period beginning on or around that date.