2-07. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Solicitation number
- UDOT260166BG
- Issued by
- Utah
About this file
This is a submittal certification form for vendors responding to the Utah Department of Transportation (UDOT) Invitation for Bid (IFB) for Pavement Marking Acrylic Water Based Paint. The form requires bidders to make four critical certifications regarding their eligibility and transparency as potential contractors. Vendors must certify whether they have been debarred, suspended, proposed for debarment, or declared ineligible by any government agency at the international, national, state, or local level. Additionally, bidders must disclose any conflicts of interest or potential conflicts of interest that could arise during contract performance, confirm the absence of outstanding tax liens in the State of Utah, and reveal any other material information not included in their proposal that could impact the state's determination of vendor responsiveness or contract award eligibility.
This certification form serves as a mandatory compliance document in the procurement process, ensuring that only qualified and eligible vendors proceed with their bids for the pavement marking paint contract. Vendors must respond with either "No" or "Yes" to each certification question, and any affirmative response requires a detailed written explanation of the circumstances. The form references Utah Code Annotated sections 63G-6a-120 and 902, establishing the legal framework for these disclosure requirements and emphasizing the state's commitment to transparency, accountability, and regulatory compliance in the procurement process.
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| 6-02b. 2026 Standard Specifications Waterborne Paint.pdf | ||
| 7-06. Submittal Form- Paint Pricing Sheet.docx | DOCX document | |
| 8-02a. Scope of Work Paint Contract 2021V2.docx | DOCX document | |
| 4-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 5-01. IFB General Bid Information2.doc | DOC document | |
| 3-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 1-05. Attachment A- Agency Terms and Conditions.docx | DOCX 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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