2-07. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Solicitation number
- UDOT260155MP
- Issued by
- Utah
About this file
This is a submittal form for certifications required by the Utah Department of Transportation (UDOT) for an Invitation for Bid (IFB) solicitation regarding Uninterruptable Power Supply System Maintenance and Repair Services. The form requires vendors to certify their status regarding debarment, suspension, or ineligibility by any government agency; disclose any conflicts of interest or potential conflicts of interest that may arise during contract performance; declare whether they have outstanding tax liens in the State of Utah; and provide any other material information not already included in their proposal that could impact the state's determination of vendor responsiveness for contract award, including legal actions, personnel changes, loss of major contracts, or alleged violations of federal, state, or local regulations.
Vendors must respond to each certification section by selecting either "No" or "Yes" and must provide detailed explanations of circumstances for any affirmative responses. This certification form is mandatory for participation in the UDOT procurement process and serves as a compliance document to ensure vendor eligibility and integrity in the bidding process. The form references the Utah Procurement Code (UCA 63G-6a) and requires vendors to attest to their qualifications and good standing before contract award consideration.
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Other files
| File | Type | Posted |
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| 4-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 5-06. Submittal Form- Pricing.xlsx | XLSX spreadsheet | |
| 7-01. IFB General Bid Information.doc | DOC document | |
| 3-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 6-02. Scope of Work and Specifications 2026-01-22.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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