5-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT IDIQ - Electrical Contractors for EVSE
- Solicitation number
- UDOT270061MP-1
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required by the Utah Department of Transportation (UDOT) Procurement Services for the IDIQ Electrical Contractors for Electric Vehicle Supply Equipment (EVSE) contract opportunity. The form requires vendors to certify their status across four critical areas: debarment history, conflict of interest, outstanding tax liens in Utah, and any other material information that could impact the State's determination of vendor responsiveness for contract award. Vendors must answer yes or no to each certification question, and any affirmative response requires a detailed written explanation of the circumstances.
The certifications align with Utah Code Annotated (UCA) 63G-6a-120 and 902 requirements and serve as gatekeeping provisions for the multiple contract awards being issued. Vendors are expected to disclose any history of debarment, suspension, or ineligibility from any government entity; any potential conflicts of interest arising during contract performance; any outstanding state tax liens; and any legal actions, personnel changes, contract losses, or alleged regulatory violations that could influence the State's evaluation. These certifications are mandatory compliance documents that must be completed and submitted as part of the vendor's proposal to be considered for award.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-02. Attachment B- AVL Scope of Work for Approved Vendor List.docx | DOCX document | |
| 3-03. Submittal Form- Vendor Set Up Form And W-9.pdf | ||
| 8-01. Solicitation Information- IDIQ 2026-11-02.doc | DOC document | |
| 7-08. Map- 5 regions.pdf | ||
| 4-05. Submittal Form- Attachment A- Agency Terms and Conditions- Yes No.docx | DOCX document | |
| 2-06. Sample Score Sheet.doc | DOC document | |
| 6-04. 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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