4-7. Submittal Form- Vendor Set Up Form 2024-06-27 (4).pdf
PDF 8 MB Posted
- Attached to
- UDOT Region 1 Cover Material
- Solicitation number
- UDOT260195CN
- Issued by
- Utah
About this file
This is a Vendor Set Up Form submittal document for the Utah Department of Transportation (UDOT) Region 1 Cover Material procurement solicitation. The document is part of an Invitation for Bid (IFB) issued under solicitation number UDOT260195CN (also referenced as UDOT260144CN) for the supply and delivery of cover material to specified drop points throughout the region. The contract will be awarded to the lowest responsive and responsible bidder, with cover material required to be delivered before May 21, 2026. The UDOT Procurement Services Division and Region 1 Conducting Procurement Unit are the responsible agencies overseeing this solicitation in accordance with the State of Utah Procurement Code and Utah Administrative Code.
The Vendor Set Up Form serves as a critical submittal requirement for bidders to establish or verify their vendor information and eligibility to participate in this procurement. Bidders must complete and submit this form along with sufficient documentation and information demonstrating compliance with all stated specifications and requirements. The form establishes the administrative foundation for vendor registration within UDOT's system, ensuring that responsive and responsible bidders are properly identified and vetted before contract award. All bids, correspondence, and documentation submitted must reference the solicitation number UDOT260195CN to ensure proper tracking and processing of the procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-Attachment-A-Agency-Terms-and-Conditions-GS.docx | DOCX document | |
| 2-Attachment B Scope of Work.pdf | ||
| 3-Attachmnet C Bid sheet Region 4 Cover Material Stockpile Locations C.Y. 2024.xlsx | XLSX spreadsheet |
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Text version
Creation
Modification
VENDOR/CUSTOMER CREATION/MODIFICATION
Note: Some features may not work when completing the form in the browser. Please download forms to a PDF before entering information. All forms are downloadable PDFs.
Vendor
Customer
No Yes
Address Information
Address 1 City, State, ZIP Address Type Payment Billing Ordering
Payment Billing Ordering
Address 2 City, State, ZIP Address Type Address 3 City, State, ZIP Address Type Payment Billing Ordering Contact
Email Primary Contact Phone Number Email for EFT Remittance, if applicable
Attestation
All of the information contained in this form is true and accurate to the best of my knowledge. I hereby certify that I am an authorized representative of the business and am acting in that authority and on behalf of the vendor listed above.
You are asked to provide this information to generate a valid profile in the State's Accounting system so agencies of the State can create payments or billing requests for your business.
Intended Uses of the Information The State of Utah will use this information to create a profile in our accounting system so payment or invoices can be made for your business.
Consequences for Refusing to Provide the Information
Failure to provide the requested information will prevent your profile from being valid and payment/invoices will not be generated resulting in loss of income or other collection methods to be used
Data Sharing
This information may be shared with other State Agencies to allow transactions to be processed. This information may be shared with financial institutions to generate payment and the IRS to record 1099 reporting
Preferred Payment Method EFT Check
TIN Type
Legal/Individual Name DBA if Applicable Does the Vendor have an Active Contract? Yes Tax Reporting
No If yes, enter a contract number
Tax ID Number (TIN) Organization Type
1099 Classification 1099 Reportable
Reason for Data Collection
Notice of Personal Information Data Collection UCA 63G-2-601(2)
The data collected by this form is part of record series VEND/CUST FINET, FINET Vend Cust Table, 30547 and 30546
Signature DateSigner Name
Agency Information
Agency Contact
Department Name
Department Number
URS Attestation
Is the vendor currently receiving retirement benefits from Utah Retirement Systems (URS)?
(UCA 49-11-12 Post Retirement Reemployment Restrictions Act)
PaymentPlus (Virtual Card)*If Selected Complete Form FI 171 tadarrington Underline tadarrington Underline tadarrington Underline tadarrington Line tadarrington Line
| Vendor Creation Modification Form FI170.pdf |
| W-9.pdf |
| Select One:: Yes |
| Title: |
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| Vendor: Yes |
| Customer: Off |
| No: Yes |
| Yes: Off |
| Check: Off |
| PayPlus: Off |
| Payment: Off |
| Billing: Off |
| Ordering: Off |
| Date3_af_date: |
| Sig Name: |
| Agency Contact: Mark R Parry |
| Department Name: UDOT Procurement |
| Department Number: 810 |
| Legal Name: |
| Registered DBA: |
| Individual/Sole Prop: Off |
| C Corp: Off |
| S Corp: Off |
| Partnership: Off |
| Trust/Estate: Off |
| LLC: Yes |
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| Other: Off |
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| Foreign Partners: Off |
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| EFT: Off |
| Contract Yes: Off |
| Contract No: Off |
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| Organization Type: [ ] |
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