07-_Bidder_Information_Form_CP-076.pdf

PDF 189 KB Posted

Attached to
81st Annual Educational Conference Contract
Solicitation number
EV00000622
Issued by
Tulsa County, Oklahoma

About this file

This is a Bidder Information Form (OMES Form CP 076) issued by the Oklahoma Office of Management and Enterprise Services (OMES) for Solicitation #EV00000622. The form is designed to collect essential information from bidders including their Federal Employer ID/SSN, supplier ID, company details, and contact information including address, phone, email, and website.

The form requires bidders to declare whether they are participating in a boycott of Israeli goods/services, verify their registration with the Oklahoma Secretary of State (if bid exceeds $250,000), provide proof of workers' compensation insurance coverage, and indicate if they qualify as a service-disabled veteran business under the Disabled Veteran Business Enterprise Act. Service-disabled veteran businesses must provide certification of status, proof of at least 51% ownership by service-disabled veterans, and verification of management control by service-disabled veterans.

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Text version

OMES FORM CP 076 Rev. 11/2020 PAGE 1 OF 2

Responding Bidder Information

“Certification for Competitive Bid and Contract” MUST be submitted along with the response to the Solicitation.

1. RE: Solicitation # EV00000622

2. Bidder General Information:

FEI / SSN : Supplier ID:

Company Name:

3. Bidder Contact Information:

Address:

City: State: Zip Code:

Contact Name:

Contact Title:

Phone #: Fax #:

Email: Website:

4. Bidder currently engaged in a boycott of goods or services from Israel.

YES

NO

5. Registration with the Oklahoma Secretary of State: (if over $250,000) YES - Filing Number:

NO - Prior to the contract award, the successful bidder will be required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (www.sos.ok.gov or 405-521-3911).

6. Workers’ Compensation Insurance Coverage:

Bidder is required to provide with the bid a certificate of insurance showing proof of compliance with the Oklahoma Workers’ Compensation Act.

YES – Include with the bid a certificate of insurance.

NO – Exempt from the Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11) – Attach a written, signed, and dated statement on letterhead stating the reason for the exempt status.1

1 For frequently asked questions concerning workers’ compensation insurance, see https://www.ok.gov/wcc/Insurance/index.html http://www.sos.ok.gov/ https://www.ok.gov/wcc/Insurance/index.html

OMES FORM CP 076 Rev. 11/2020 PAGE 2 OF 2

7. Disabled Veteran Business Enterprise Act

YES – I am a service-disabled veteran business as defined in 74 O.S. §85.44E. Include with the bid response 1) certification of service-disabled veteran status as verified by the appropriate federal agency, and 2) verification of not less than 51% ownership by one or more service-disabled veterans, and 3) verification of the control of the management and daily business operations by one or more service-disabled veterans.

NO – Do not meet the criteria as a service-disabled veteran business.

Authorized Signature Date

Printed Name Title

File details come from the government source that posted it. Updated .