2-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Solicitation number
- UDOT260267MP-1
- Issued by
- Utah
About this file
This is a Submittal Form—Certifications document for the Utah Department of Transportation (UDOT) related to the solicitation for Battery Powered Tote Mixers. The form requires bidders to certify their status regarding debarment, conflict of interest, outstanding tax liens, and other relevant information that may impact the State's evaluation of vendor responsiveness. The underlying solicitation seeks to procure six battery-powered paint tote mixers according to specified requirements. Bidders must submit detailed specifications and drawings demonstrating that their products meet all stated requirements. The solicitation was reissued in lieu of a previous solicitation notice. Units must be delivered prior to the fiscal year end of June 30, 2026, and award is anticipated to be made to a single provider in accordance with the Utah Procurement Code and applicable Utah Administrative Code rules.
Vendors responding to this solicitation are required to certify they have not been debarred, suspended, proposed for debarment, or declared ineligible by any governmental agency; that they have no conflicts of interest or potential conflicts that would arise during contract performance; that they do not have outstanding tax liens in the State of Utah; and that they have disclosed any other material information not included in their proposal that could impact the State's determination of vendor responsiveness, including legal actions, personnel changes, loss of major contracts, or alleged violations of federal, state, or local regulations. Bidders must provide sufficient documentation and information to demonstrate full compliance with all stated specifications and requirements as part of their bid submissions.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-02. Specifications- IN LIEU OF.docx | DOCX document | |
| 4-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 3-05. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 1-04. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 5-01. IFB General Bid Information- IN LIEU OF.doc | DOC document | |
| 7-06. Submittal Form- Pricing- IN LIEU OF.doc | DOC document |
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Text version
Certifications- Debarment, Conflict of Interest, Outstanding Tax Lien, Other Information
1. DEBARMENT- Is vendor presently or has vendor ever been debarred, suspended, proposed for debarment, or declared ineligible by any government department or agency, whether international, national, state, or local? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I have not been debarred, suspended, proposed for debarment, or declared ineligible.
Yes, I am or have been debarred, suspended, proposed for debarment, or declared ineligible (see as follows):
2. CONFLICT OF INTEREST- Does Vendor have any conflict, or potential conflict of interest, that might arise during the contract? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have any Conflict or Potential Conflict of Interest.
Yes, I do have a Conflict or Potential Conflict of Interest (see as follows):
3. OUTSTANDING TAX LIEN- Does vendor have an outstanding tax lien in the State of Utah? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have an outstanding Tax Lien.
Yes, I do have an outstanding Tax Lien (see circumstances as follows):
4. OTHER INFORMATION- Does vendor have any information that is not already provided within its proposal that if known to the State would impact the State’s determination on vendor's responsiveness for a contract award (i.e., legal action, recent turn-over in major personnel, loss of a major contract, any alleged violations of federal, state or local regulations, etc.). Please see UCA 63G-6a-120 & 902. If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have any Other Information.
Yes, I do have Other Information (see as follows):
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