1-ERC_Affirmation_and_Disclosure_Form.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Environmental Remediation Contractor, LLC as the primary contractor. The form involves the State of Ohio and ODOT (Ohio Department of Transportation), with two subcontractors listed: Allied Environmental Services and Valicor Environmental Services. The document addresses compliance with Executive Order 2022-02D, which prohibits state agencies from purchasing services from Russian companies or institutions, and requires disclosure of contract and service location details.

The contract services appear to be environmental in nature, to be performed within the State of Ohio, with the contractor's principal business location at 370 North Eureka Avenue in Columbus, OH. The subcontractors are located in Lima and Monroe, Ohio. The document emphasizes that no services will be performed outside the United States, and the contractor agrees to notify the state of any potential changes in service locations. The form includes provisions for data handling, with specific requirements about state data storage and transmission, and requires an original signature to validate the contractual agreements.