101g-26_affirmation___disclosure_form-_Tri_County_Asphalt_Materials__Inc..pdf

This document is an Affirmation and Disclosure Form for a state contract, specifically related to the Ohio Department of Transportation (ODOT) and involving Tri-County Asphalt Materials, Inc., located in North Lima, Ohio. The form is associated with Executive Order 2022-02D and addresses restrictions on purchasing services from Russian companies or institutions, in compliance with state procurement guidelines.

The contract details indicate that Tri-County Asphalt Materials, Inc. will perform services at 405 Andrews Ave. in Youngstown, OH, with the primary business location at 11899 South Ave. in North Lima, OH. The form affirms that no services will be performed in Russia, and the company agrees to notify the state of any changes in subcontractor information or service locations. The document is dated February 17, 2025, and was signed by Richard T. Vernal III, Vice President, formally acknowledging the terms and conditions of the state contract.