13100_EV0568_OMESFormCP076.pdf
PDF 188 KB Posted
- Attached to
- Washing Machine
- Solicitation number
- EV00000568
- Issued by
- Cleveland County, Oklahoma
About this file
This document is an OMES (Office of Management and Enterprise Services) FORM CP 076 "Certification for Competitive Bid and Contract" related to Solicitation #EV00000568. The form requires the responding bidder to provide general information including their Employer Identification Number/Social Security Number, Supplier ID, company name, contact information, and confirm whether they are currently engaged in a boycott of goods or services from Israel. The bidder must also indicate if they are registered with the Oklahoma Secretary of State and provide a certificate of insurance showing proof of workers' compensation coverage or claim an exemption. Additionally, the form asks if the bidder qualifies as a service-disabled veteran business enterprise.
The document outlines the general requirements and certifications needed for this state-level competitive bid and contract opportunity, but does not provide details on the specific products, services, quantities, timeline, or other salient information about the solicitation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_B-NegotiableTerms.docx | DOCX document | |
| Attachment_C-Agency_Terms.pdf | ||
| BID_PACKET_ATTACHMENTS_INSTRUCTIONS.pdf | ||
| 13100_EVO568_OMES_FormCP004.pdf | ||
| EV00000568_Bidder_Instructions.pdf | ||
| Attachment_A-Solicitation.pdf |
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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 $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
EV00000568
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 .