3-09. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Attached to
- UDOT RFP- Siting Assessment and Economic Impact Analysis of a Potential Spaceport in Utah
- Solicitation number
- UDOT260154MP
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications addressing debarment, conflict of interest, outstanding tax liens, and other information relevant to vendor responsiveness for the Utah Department of Transportation's Request for Proposals regarding a Siting Assessment and Economic Impact Analysis of a Potential Spaceport in Utah. The form requires vendors to certify whether they have been debarred, suspended, proposed for debarment, or declared ineligible by any government department or agency at the international, national, state, or local level, and to disclose any conflicts or potential conflicts of interest that might arise during contract performance. Vendors must also declare whether they have outstanding tax liens in the State of Utah and provide explanations for any affirmative responses.
The form additionally requires vendors to disclose any other information not already provided in their proposal that could impact the State's determination of vendor responsiveness for contract award, including legal actions, recent turnover in major personnel, loss of major contracts, or alleged violations of federal, state, or local regulations, as outlined in Utah Code Annotated sections 63G-6a-120 and 902. This certification document serves as a critical component of the vendor's proposal submission, establishing compliance with Utah's procurement requirements and ensuring that selected contractors meet the State's standards for eligibility and reliability.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .