1-Scan_0044.pdf

This document is an Affirmation and Disclosure Form for a state contract, specifically involving Asphalt Systems Ohio Inc., located in Sidney, Ohio. The form is related to a contract with the Ohio Department of Transportation (ODOT) and pertains to services to be performed within the State of Ohio, with the contractor affirming compliance with Executive Order 2019-12D regarding the expenditure of public funds and restrictions on services performed by Russian companies or institutions.

The contractor indicates that services will be performed within agencies in the State of Ohio with authority to purchase cooperative (co-op) indefinite delivery vehicles (IDV). The principal business location and state data location are both at 2500 Fair Rd., Sidney, OH 49365. The document emphasizes the contractor's agreement to abide by state regulations, including immediate disclosure of any changes in contract location or services, and confirms that no services will be performed in Russia. The form was signed by the company president on 03.18.2025, representing Asphalt Systems Ohio Inc.'s commitment to the contract's terms and conditions.