4-09. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 17 KB Posted
- Solicitation number
- UDOT260084MP
- Issued by
- Utah
About this file
This document is a Submittal Form for Certifications related to a Utah Department of Transportation (UDOT) Request for Proposals (RFP) for Fiber Optic and ATMS Construction Services. The solicitation seeks qualified firms to provide construction services with a contract period ending on 03/31/2028 and anticipates multiple contract awards. Contractors will be selected to perform fast-turnaround, straightforward construction services, with compensation determined by line-item pricing based on actual work performed. The State of Utah reserves the right to reopen the solicitation and invite additional contractors to submit responses at any time.
The submittal form requires vendors to disclose critical information including any history of debarment, potential conflicts of interest, outstanding tax liens, and other relevant information that might impact the state's determination of the vendor's responsiveness. Vendors must comply with UDOT's specific standards and specifications, and the form provides structured sections for vendors to transparently report any potential issues that could affect their eligibility for contract award. The RFP emphasizes transparency and requires vendors to provide detailed explanations for any affirmative responses to the certification questions.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 8-03. Items Listing MP Revision 2025-09-29.docx | DOCX document | |
| 5-04. Delineator Std Specification.pdf | ||
| 1-08. Submittal Form- Attachment A- Standard Terms and Conditions- with check fields.docx | DOCX document | |
| 12-11. Map- Regional Map- UDOT Fiber RFP Region 4 Split.pdf | ||
| 7-10. Sample Score Sheet 2025-09-29.doc | DOC document | |
| 10-02. Scope of Work- 2025-09-30 AMENDED.doc | DOC document | |
| 9-0. AMENDMENT 1- 2025-09-30.doc | DOC document | |
| 6-06. Submittal Form- Vendor Setup Form.pdf | ||
| 11-05. Submittal Form- Pricing- All Regions- 2025-09-30 AMENDED.xlsx | XLSX spreadsheet | |
| 3-01. RFP General Information- 2025-09-29.doc | DOC document | |
| 2-07. Submittal Form- Business Confidentiality- check fields.doc | DOC document |
Show all 11
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 .