Scanner_20250211_102254.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically for Ohio Asphalt Limestone Corp. The form is associated with the Ohio Department of Transportation (ODOT) and addresses requirements for performing services, with a focus on compliance with Executive Order 2019-12D regarding restrictions on services from Russian companies or institutions. The primary location of business is listed as 8591 Mad River Rd in Hillsboro, OH 45133.

The form emphasizes the contractor's agreement to perform services exclusively within the specified location, with no services to be conducted in Russia. The document requires disclosure of the principal business location, service performance location, and state data location, all of which are consistent at the 8591 Mad River Rd address. The form was signed by the owner, Craig S. Jones, on February 11, 2025, and includes provisions about prohibitions on purchasing services from Russian companies, with ODOT reserving the right to recover any funds paid for services under this contract.