Orion_Solutions_Affirmation_and_Disclosure_Form_080524.pdf

This document is an Affirmation and Disclosure Form related to an Ohio Department of Transportation (ODOT) contract, specifically addressing restrictions on expenditure of public funds for services performed by Russian companies or institutions. The form is completed by Orion Sustainable Solutions, LLC, with a principal business location at 1035 Franklin St., Ste 207 in Rocky Mount, VA 24151. The document is part of a contract that requires compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies.

The form indicates that no subcontractors are involved (marked as N/A), and the services will be performed at the same address as the principal business location. The contractor affirms that they will not perform any services in Russia and agrees to immediately notify the state of any changes in service location. The document was signed by the CFO on 8/5/24, demonstrating the company's commitment to the contractual requirements and restrictions on service delivery related to Russian entities. The form serves as a formal disclosure and affirmation of the contractor's compliance with state procurement guidelines.