3-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT IFB- UDOT Region 4 Sand Blasting, Painting, Welding, and Fabrication- Price Area - IN LIEU OF
- Solicitation number
- UDOT270035MP-2
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required by the Utah Department of Transportation (UDOT) for the UDOT Region 4 Sand Blasting, Painting, Welding, and Fabrication contract solicitation. The form requires vendors to provide certifications regarding their eligibility and standing to perform government contracts. Bidders must respond to four certification categories: debarment status, conflict of interest disclosures, outstanding tax liens in the State of Utah, and any other material information that could impact the state's determination of vendor responsiveness. The form is structured to allow vendors to select either "No" or "Yes" responses to each certification category, with affirmative responses requiring written explanation of circumstances.
Vendors responding to this solicitation must complete all certification requirements as part of their proposal submission. Any vendor answering "Yes" to debarment, conflict of interest, tax lien status, or other information questions must provide detailed statements explaining the circumstances in accordance with Utah Code Annotated sections 63G-6a-120 and 902. The certifications serve as threshold requirements to establish vendor eligibility and responsibility for contract consideration. Failure to accurately complete certifications or provide required explanations for affirmative responses may render a bid non-responsive or result in bid rejection during the evaluation process.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-05. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 4-04. Submittal Form- Vendor Set Up Form.pdf | ||
| 2-06. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 7-03. Submittal Form- Pricing- AMENDED 2026-09-14.pdf | ||
| 6-01. IFB General Bid Information.doc | DOC document | |
| 5-02. Scope of Work.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):
File details come from the government source that posted it. Updated .