1-affirmation_disclosure_and_coi.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving the Ohio Department of Transportation (ODOT) and Broad & James Inc., located in Columbus, OH. The form addresses requirements under Executive Order 2022-02D concerning restrictions on services performed by Russian companies or in Russia, emphasizing compliance with state procurement regulations and prohibitions on offshore services.

The contract appears to be a service-based agreement where Broad & James Inc. will perform services at 4301 E. 5th Ave. in Columbus, OH 43219, with all state data to be located at the same address. The document is accompanied by a Certificate of Liability Insurance from Employers Mutual Casualty Co., covering commercial general liability, automobile liability, and workers' compensation with various coverage limits ranging from $500,000 to $3,000,000. The insurance policy is valid from 10/01/2024 to 10/01/2025, indicating a potential one-year contract period with possible renewal options.