10_-_Fillable_OMESFormCP076.pdf
PDF 230 KB Posted
- Attached to
- Medical Waste Disposal
- Solicitation number
- EV00000688
- Issued by
- Beaver County, Oklahoma
About this file
This document is an OMES (Office of Management & Enterprise Services) "Responding Bidder Information" form for a competitive bid and contract opportunity in Oklahoma, specifically for Solicitation #EV0000688. The form requires bidders to provide comprehensive company and contact information, and to certify compliance with various state requirements including registration with the Oklahoma Secretary of State, workers' compensation insurance coverage, and a declaration regarding potential boycotts of Israeli goods and services.
The form includes several key certification sections, notably the Disabled Veteran Business Enterprise Act verification, where bidders must confirm whether they qualify as a service-disabled veteran business. To qualify, businesses must provide documentation proving: 1) service-disabled veteran status verified by a federal agency, 2) at least 51% ownership by service-disabled veterans, and 3) management and daily operations controlled by service-disabled veterans. The document is a standardized state procurement form (OMES FORM CP 076, revised 11/2020) that serves as a mandatory submission for potential contractors bidding on state contracts over $25,000.
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Other files
| File | Type | Posted |
|---|---|---|
| 01_-_Agency_Bid_Instructions.pdf | ||
| 03_-_Attachment_B_-_Statewide-Terms.docx | DOCX document | |
| 04_-_Attachment_C_-_OSDH_General_Terms.pdf | ||
| 09_-_Exhibit_5_-_Affirmations.docx | DOCX document | |
| 11_-_OMESFormCP004.pdf | ||
| 02_-_Attachment_A_-_Purpose___Scope.pdf | ||
| 07_-_Exhibit_3_-_ReferenceSheet-post_with_bid.pdf | ||
| 08_-_Exhibit_4_-_OSDH_CHD_Site_List.xlsx | XLSX spreadsheet | |
| 00_-_BID_PACKET_ATTACHMENTS_INSTRUCTIONS.pdf | ||
| 05_-_Exhibit_1_-_ExecutiveSummaryWorksheet.xlsx | XLSX spreadsheet | |
| 06_-_Exhibit_2_-_Cost_CI.docx | DOCX document | |
| 12_-_Amendment_1_Q_A.pdf |
Show all 12
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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 #: ______________________________________
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 $25,000)
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
| Certification for Competitive Bid and Contract MUST be submitted along with the response to the Solicitation: |
| RE Solicitation: EV00000688 |
| FEI SSN: |
| Supplier ID: |
| Company Name: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contact Name: |
| Contact Title: |
| Phone: |
| Fax: |
| Email: |
| Website: |
| Bidder currently engaged in a boycott of goods or services from Israel: Off |
| Registration with the Oklahoma Secretary of State if over 25000: |
| YES Filing Number: Off |
| NO Prior to the contract award the successful bidder will be required to register with the Secretary of: Off |
| YES Include with the bid a certificate of insurance: Off |
| NO Exempt from the Workers Compensation Act pursuant to 85A OS 218b111 Attach a: Off |
| YES I am a servicedisabled veteran business as defined in 74 OS 8544E Include with the bid: Off |
| NO Do not meet the criteria as a servicedisabled veteran business: Off |
| Date: |
| Printed Name: |
| Title: |
| Signature2_es_:signer:signature: |
File details come from the government source that posted it. Updated .