28-12. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
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- Solicitation number
- UDOT250192MP-1
- Issued by
- Utah
About this file
This is a submittal form for certifications addressing debarment, conflict of interest, outstanding tax liens, and other responsive information required by the Utah Department of Transportation (UDOT) and Utah Transit Authority (UTA) for their FrontRunner Train Sets Acquisition solicitation. The form requires vendors to certify their status regarding debarment, suspension, or ineligibility by any government agency; disclose any conflicts of interest that might arise during contract performance; confirm whether they hold outstanding tax liens in the State of Utah; and provide any additional information that could impact the State's determination of vendor responsiveness. Vendors must answer "Yes" or "No" to each certification requirement and provide detailed explanatory statements for any affirmative responses. The underlying RFP seeks qualified commuter rail vehicle manufacturers to design, manufacture, test, furnish, deliver, and performance test ten diesel multiple units (DMUs) as a base contract with options for up to forty additional DMUs as part of the FrontRunner 2X project.
The single contract award will be made to the responsive and responsible vendor achieving the highest combined technical and cost score in accordance with Utah Procurement Code and Administrative Rules. This submittal form serves as a critical compliance document in the vendor evaluation process, ensuring that only qualified and responsible contractors proceed in the procurement. Vendors must complete all certifications accurately and thoroughly, as false or misleading responses could result in disqualification from the award. All questions and comments regarding the solicitation must be submitted through the online bidding system.
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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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