11_OMES_Form_CP076-Responding_Bidder_Information.pdf
PDF 287 KB Posted
- Attached to
- SW0210 - Travel Facilitation
- Solicitation number
- EV00000679
- Issued by
- Oklahoma
About this file
This document is an Oklahoma Office of Management and Enterprise Services (OMES) Central Purchasing Responding Bidder Information form for Solicitation #EV00000679. The form requires bidders to provide comprehensive details about their business and compliance with state requirements, including confirmation of registration with the Oklahoma Secretary of State, workers' compensation insurance coverage, and potential qualification as a service-disabled veteran business enterprise.
The form includes several key compliance sections that bidders must complete, such as declaring whether they are engaged in a boycott of goods or services from Israel, verifying workers' compensation insurance status, and attesting to disabled veteran business enterprise qualifications. Bidders must provide documentation to support their claims, such as insurance certificates, ownership verification, and service-disabled veteran status certification. The form must be signed by an authorized representative and submitted as part of the bid response, with specific requirements for exemptions or additional documentation if certain conditions are not met.
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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 # EV00000679
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
Benjamin Komolafe Inserted Text
: EV
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