4-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT IFB- Battery Powered Tote Mixers
- Solicitation number
- UDOT260267MP
- Issued by
- Utah
About this file
This is a submittal form for certifications required by the State of Utah's Department of Transportation (UDOT) for participation in an Invitation for Bid (IFB) for battery-powered tote mixers. The solicitation seeks to procure six battery-powered paint tote mixers according to specifications outlined in the solicitation documents, with anticipated award to a single provider. The procurement is issued in accordance with the Utah Procurement Code and applicable administrative rules of the Utah Administrative Code, which take precedence in the event of any conflicting provisions.
The certification form requires vendors to attest to four key compliance areas: debarment status, conflict of interest, outstanding tax liens in Utah, and any other material information that could impact the state's determination of vendor responsiveness. Vendors must answer "Yes" or "No" to each certification item and provide written explanations for any affirmative responses. These certifications address whether the vendor has been debarred, suspended, or declared ineligible by any government entity; whether any conflicts of interest exist relative to contract performance; whether outstanding tax liens exist within Utah; and whether any additional information such as legal actions, personnel changes, contract losses, or alleged regulatory violations should be disclosed. Bidders are required to provide sufficient documentation and information to demonstrate compliance with stated specifications and requirements outlined in the solicitation documents.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-01. IFB General Bid Information.doc | DOC document | |
| 6-03. Submittal Form- Vendor Set Up Form.pdf | ||
| 7-02. Specifications.docx | DOCX document | |
| 2-06. Submittal Form- Pricing.doc | DOC document | |
| 5-05. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 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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