11._OMESformCP076.pdf
PDF 293 KB Posted
- Attached to
- Airborne Infection Isolation Rooms.
- Solicitation number
- EV00000960
- Issued by
- Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form used by the State of Oklahoma's Central Purchasing division for state and local contract opportunities. The form serves as a certification document that bidders must submit along with their response to solicitation EV00000960. The form requests comprehensive bidder information including FEIN/SSN, supplier ID, company name, and complete contact details for the authorized representative submitting the bid response.
The form requires bidders to certify compliance with multiple Oklahoma statutory requirements and business standards. Bidders must disclose whether they are engaged in boycotts of Israeli goods or services, confirm registration status with the Oklahoma Secretary of State (or provide exemption documentation), and provide proof of workers' compensation insurance coverage or submit a signed exemption statement. Additionally, bidders may self-certify as a service-disabled veteran business enterprise if they meet the criteria defined in 74 O.S. § 85.44E, which requires verification of service-disabled veteran status, at least 51 percent ownership by one or more service-disabled veterans, and management control by service-disabled veterans. The authorized representative must sign and date the certification form, attesting to the accuracy of the information provided.
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| 00.BID_INSTRUCTIONS_TB_Isolation_Rooms.pdf | ||
| 03._AttachmentC-AgencyTerms_.pdf | ||
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| 02._ATTACHMENT_B-General_Terms.docx | DOCX document | |
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| 06._EXHIBIT_03-PRICE_TEMPLATE_TB_Isolation_Rooms_.xlsx | XLSX spreadsheet | |
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Text version
OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1
Central Purchasing
RESPONDING BIDDER INFORMATION
You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.
1. SOLICITATION
Solicitation #
2. BIDDER GENERAL INFORMATION
FEIN/SSN Supplier ID
Company name
3. BIDDER CONTACT INFORMATION
Address
Contact name Title
Email Phone Website Fax
4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL
Yes No
5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE
Yes Filing number:
No Prior to the contract award, the successful bidder is 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 (sos.ok.gov or 405- 521-3911).
6. WORKERS’ COMPENSATION INSURANCE COVERAGE
Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.
Yes Include a certificate of insurance with the bid.
No Exempt from the Administrative 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. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)
7. DISABLED VETERAN BUSINESS ENTERPRISE ACT
Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.
Include the following with the bid response:
1. Certification of service-disabled veteran status as verified by the appropriate federal agency.
2. Verification of not less than 51% ownership by one or more service-disabled veterans.
3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.
No I do not meet the criteria as a service-disabled veteran business.
8. SIGNATURE
Authorized signature Date
Name Title https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: EV00000960 |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .