Affirmation_and_Disclosure_COI.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically involving Oberlanders Tree & Landscape, Ltd. located in Bucyrus, Ohio. The form addresses compliance with Executive Order 2022-02D regarding restrictions on services performed by Russian companies or institutions. The contractor affirms that no services will be performed outside the United States, and the State of Ohio Department of Transportation (ODOT) is the primary government agency involved in this contract.

The contract involves services to be performed at various locations within Ohio, with the contractor's principal business address at 1874 E. Mansfield St. in Bucyrus, OH. The document includes a Certificate of Liability Insurance from Cincinnati Insurance Company, covering commercial general liability, automobile liability, and workers' compensation with various policy limits. The insurance policy (ENP 0008122) is effective from 01/14/2024 to 01/14/2025 and specifically covers liability arising from pesticide application, with the State of Ohio Department of Transportation listed as an additional insured.