2-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT IFB- Group B Signs- UDOT Regions 1, 2, 3
- Solicitation number
- UDOT270097MP
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required for the UDOT IFB- Group B Signs solicitation issued by the Utah Department of Transportation for Regions 1, 2, and 3. The form requires vendors to certify their status regarding four specific areas: debarment history, conflict of interest, outstanding tax liens in the State of Utah, and other material information that could impact the State's determination of vendor responsiveness. For each certification category, vendors must select either "No" or "Yes" and provide a detailed statement explaining circumstances if they answer affirmatively.
The form serves as a compliance mechanism to ensure that only eligible vendors meeting baseline integrity and legal requirements can proceed with contract award consideration. Vendors must attest that they have not been debarred, suspended, proposed for debarment, or declared ineligible by any government entity; that no conflicts of interest exist; that no outstanding tax liens are held against them in Utah; and that no other material information exists that would affect the State's assessment of their eligibility per UCA 63G-6a-120 and 902. This certification is a mandatory component of proposal submission for the Group B sign panels and related materials and services solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| 8-02. Scope of Work- Group B Signs- Regions 1 2 3.doc | DOC document | |
| 4-03. Submittal Form- Vendor Set Up Form And W-9.pdf | ||
| 7-06. Submittal Form- Pricing- Group B Signs- All regions- 2026-11-09.xlsx | XLSX spreadsheet | |
| 3-04. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 1-05. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 9-01. IFB General Bid Information.doc | DOC document | |
| 5-08. Title VI.docx | DOCX document | |
| 6-09. Map- 5 regions.pdf |
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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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