2-07. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Solicitation number
- UDOT260039MP
- Issued by
- Utah
About this file
This is a submittal form for certifications related to a Utah Department of Transportation (UDOT) Invitation for Bid (IFB) for UDOT Region 3 Repair of Hydraulic Lift Apparatus covering the Basin Area. The form requires vendors to certify their eligibility and provide relevant information regarding debarment status, conflicts of interest, outstanding tax liens, and any other material information that could impact the state's determination of vendor responsiveness. The solicitation is issued in accordance with the Utah Procurement Code and applicable administrative rules of the Utah Administrative Code, with these governing documents taking precedence in case of any conflicts with the solicitation documents.
The certification form consists of four primary sections in which vendors must declare their status: debarment or suspension by any government agency; conflicts or potential conflicts of interest that might arise during contract performance; outstanding tax liens in the State of Utah; and any other information not previously disclosed in the proposal that could impact the state's responsiveness determination, including legal actions, personnel changes, loss of major contracts, or alleged violations of federal, state, or local regulations. Vendors must affirmatively answer whether they meet each criterion and provide detailed explanatory statements if any answer is affirmative, as required under Utah Code Annotated sections 63G-6a-120 and 902.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-02. R3 Hydraulic Lift Repair Scope of Work- revised.docx | DOCX document | |
| 7-01. IFB General Bid Information.doc | DOC document | |
| 1-05. Attachment A- Agency Terms and Conditions.docx | DOCX document | |
| 4-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 5-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 6-06. R3 Hydraulic Lift Repair Attachment D Price Sheet Revised 10022025.xlsx | XLSX spreadsheet |
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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):
File details come from the government source that posted it. Updated .