4-06. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT IFB- Tau Systems Crash Cushion and End Treatment Systems and Parts- ADDITIONAL PROVIDER
- Solicitation number
- UDOT260297MP
- Issued by
- Utah
About this file
This is a certification and submittal form for a state and local contract opportunity issued by the Utah Department of Transportation (UDOT) for the procurement of an additional provider of Tau Systems Crash Cushion and End Treatment systems and parts. The solicitation is issued under the Utah Procurement Code and applicable administrative rules, with the anticipated award of a single contract to one additional provider who can meet the specified requirements outlined in the solicitation documents. Bidders are required to provide comprehensive documentation and information demonstrating their compliance with all stated specifications and requirements to be considered for contract award.
The submittal form requires vendors to certify their status regarding four critical compliance areas: debarment history with any government department or agency at the international, national, state, or local level; any existing or potential conflicts of interest that may arise during contract performance; outstanding tax liens in the State of Utah; and any other material information not previously disclosed in the proposal that could impact the state's determination of vendor responsiveness, including legal actions, personnel changes, contract losses, or alleged regulatory violations. Vendors must answer affirmatively or negatively to each certification requirement, with detailed written explanations required for any "Yes" responses to ensure full transparency in the procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| 5-01. IFB General Bid Information- Additional Provider.doc | DOC document | |
| 2-05. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 6-02. Crash Cushion SOW- updated.docx | DOCX document | |
| 3-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 1-04. Submittal Form- Business Confidentiality- Yes No.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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