2-07. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Attached to
- UDOT IFB- Deicer Testing
- Solicitation number
- UDOT260177MP
- Issued by
- Utah
About this file
This is a submittal certification form for the Utah Department of Transportation (UDOT) Deicer Testing Invitation for Bid (IFB), requiring vendors to certify their eligibility and responsibility status prior to contract award. The form obligates bidders to disclose 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, vendors must certify the absence of conflicts of interest or potential conflicts of interest that could arise during contract performance, confirm they do not have outstanding tax liens in the State of Utah, and disclose any other material information not previously provided 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 as referenced in Utah Code Annotated sections 63G-6a-120 and 902.
The certification form requires vendors to respond with either affirmative or negative answers to each of the four disclosure categories. For any affirmative response, vendors must provide detailed written statements explaining the circumstances. This form serves as a critical compliance document within the broader solicitation framework for the Deicer Testing contract and represents a standard pre-award responsibility and eligibility verification requirement under the Utah Procurement Code. No specific pricing, set-asides, incumbent information, or funding details are contained within this particular certification document, as it functions solely as a vendor qualification and disclosure instrument.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-05. Attachment A- Agency Terms and Conditions.docx | DOCX document | |
| 6-06. Submittal Form- Pricing Sheet- Deicer Testing.xlsx | XLSX spreadsheet | |
| 5-02. Scope of Work- Deicer testing.docx | DOCX document | |
| 4-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 3-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 7-01. IFB General Bid Information.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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