OHDOT_-_Affirmation_and_Disclosure_Form_-_318-25_Troxler_Model_3440_Plus_Surface_Moisture_Density_Gauges_or_equivalent__2024_.pdf

This document is an Affirmation and Disclosure Form related to Executive Order 2022-02D, specifically addressing restrictions on services performed by Russian companies or institutions. The form is completed by Instrotek Inc., located at 1 Triangle Drive in Research Triangle Park, NC 27709, and is associated with a contract potentially involving the Ohio Department of Transportation (ODOT). The document ensures compliance with executive orders prohibiting state agencies from purchasing offshore services from Russian entities.

The form indicates that Instrotek will perform all contract services at its primary business location in Research Triangle Park, NC, with no subcontractors involved. The company affirms that it will not perform any services in Russia and agrees to immediately notify the state of any changes in service locations. The document is signed by Josh Shane, a Regional Sales Representative, on 05/23/2024, and appears to be related to a potential procurement of scientific or measurement equipment, potentially surface moisture density gauges, though the specific goods are not detailed in this disclosure form.