Agro_Chem_Affirm___Disclosure.pdf

This document is an Affirmation and Disclosure Form related to a state contract, specifically addressing requirements outlined in Executive Order 2022-02D. The form is completed by Agro Chem East, located at 1652 St. Rt. 22+3 E in Wilmington, OH 45177. The document pertains to the Ohio Department of Transportation (ODOT) and adheres to state guidelines regarding service performance, data handling, and restrictions on offshore services.

The form specifies that Agro Chem East will perform services at their primary business location in Wilmington, OH, with no subcontractors involved. The contract is subject to Executive Order 2019-12D, which prohibits the use of public funds for services performed by Russian companies or institutions. The contractor affirms that no services will be performed in Russia and agrees to immediately notify the state of any potential changes in service location. The document was signed on 1/21/2025 by Brent M. Achtermann in the Sales role, and is part of a broader contract with the state of Ohio.