scan0042.pdf

This document is an Affirmation and Disclosure Form for Northstar Asphalt, Inc., located in North Canton, Ohio, as part of a contract with the Ohio Department of Transportation (ODOT). The form specifically addresses compliance with Executive Order 2022-02D regarding restrictions on services from Russian companies or institutions, affirming that no services under this contract will be performed in Russia.

The contract involves services to be performed at various locations, with the company's principal business address at 7345 Sunset Strip NW in North Canton, OH. No subcontractors are listed on this form. The document emphasizes that the contractor agrees to abide by the executive order, which prohibits the purchase of services from Russian companies or institutions, and reserves ODOT's right to recover funds and terminate the contract if these terms are violated. The form was signed by the company president on February 26, 2025, formally documenting the company's commitment to these contractual requirements.