2-07. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Attached to
- UDOT IFB- Deicer Testing - IN LIEU OF
- Solicitation number
- UDOT260177MP-1
- Issued by
- Utah
About this file
This is a submittal form for the Utah Department of Transportation (UDOT) Deicer Testing Invitation for Bid (IFB), requiring bidders to certify their status regarding debarment or suspension, conflicts of interest, tax liens, and responsiveness to solicitation requirements. The form serves as a compliance document that qualified suppliers must complete to demonstrate eligibility to contract with the state of Utah for deicer testing services as outlined in the associated Scope of Work and specifications. This solicitation is issued under the Utah Procurement Code and applicable Utah Administrative Code rules, with the form functioning as a mandatory declaration of the bidder's legal and financial standing.
The submittal form requires bidders to attest to their compliance with state and federal regulations prohibiting debarment or suspension from government contracts, disclose any potential conflicts of interest, confirm the absence of outstanding tax liens, and confirm their responsiveness to the solicitation requirements. Bidders must provide sufficient documentation and information demonstrating compliance with all stated specifications and requirements. This form is a critical component of the bidding process and must be completed accurately and truthfully as part of the overall proposal submission package for the deicer testing contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 4-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 6-06. Submittal Form- Pricing Sheet- Deicer Testing.xlsx | XLSX spreadsheet | |
| 7-01. IFB General Bid Information.doc | DOC document | |
| 5-02. Scope of Work- Deicer testing.docx | DOCX 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):
File details come from the government source that posted it. Updated .