5-08. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Attached to
- UDOT RFP- NEMA Signal Cabinets
- Solicitation number
- UDOT260266MP
- Issued by
- Utah
About this file
This is a Submittal Form containing Certifications for the Utah Department of Transportation (UDOT) Request for Proposals for NEMA Signal Cabinets. The form requires vendors to provide declarations regarding their eligibility and any circumstances that could impact the State's evaluation of their proposal. Vendors must certify whether they have been debarred, suspended, proposed for debarment, or declared ineligible by any government entity; whether they have any conflicts of interest or potential conflicts of interest that could arise during contract performance; whether they have outstanding tax liens in the State of Utah; and whether they possess any other material information not included in their proposal that could affect the State's determination of vendor responsiveness. The RFP seeks qualified firms to provide National Electrical Manufacturers Association (NEMA) TS-2 Type 1 Size 5, Size 6, and Size 6 Stretch traffic signal control modular cabinet assemblies for signalized intersections throughout Utah. Multiple contract awards are anticipated from this solicitation.
The certification form does not address pricing, set-asides, incumbency status, or funding information. Rather, it serves as a compliance and disclosure document requiring vendors to attest to their legal standing and financial condition under Utah Code Annotated sections 63G-6a-120 and 902. Vendors must select either "No" or "Yes" for each certification question, and any affirmative responses require vendors to provide detailed written explanations of the circumstances. This document is a mandatory component of the proposal submittal process and functions as part of UDOT's evaluation criteria to ensure vendor responsibility and integrity in the procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-07. Submittal Form- Attachment A- Standard Terms and Conditions- Yes No.docx | DOCX document | |
| 4-09. Sample Score Sheet- NEMA TS 2.doc | DOC document | |
| 3-06. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 8-05. Submittal Form- Vendor Setup Form.pdf | ||
| 9-01. RFP General Information.doc | DOC document | |
| 10-09. Sample Score Sheet- ATC.doc | DOC document | |
| 6-02. Attachment B - Scope of Work- NEMA TS 2.docx | DOCX document | |
| 7-03. Attachment C - Scope of Work- ATC.docx | DOCX document | |
| 1-04. Submittal Form- Attachment D - Cost Proposal.xlsx | XLSX spreadsheet |
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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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