5. Attachment B - Vendor Disclosure Stmt.pdf

Attachment B State of Colorado – Contract Management Information

Vendor Disclosure Statement Colorado Revised Statues §24-102-206

Contract Performance Outside of the United States or Colorado Prior to contracting, or as a requirement for the solicitation of any contract for services from the State of Colorado, a prospective vendor is required to disclose the following information in a statement of work.

Completing this Form To the extent the following information has not previously been disclosed in a statement of work, a prospective vendor shall complete this Vendor Disclosure Statement and return it to the contracting state agency or institution of higher education (IHE).

This Disclosure Statement is not required for contracts under Medicare, the “Colorado Medical Assistance Act”, Articles 4 to 6 of Title 25.5 C.R.S., the “Children Basic Health Plant Act”, Article 8 of Title 25.5, C.R.S, or the “Colorado Indigent Care Program”, Part I of Article 3 of Title 25.5 C.R.S.

This Disclosure Statement is not required for Construction contract.

1. Solicitation Number:

State Agency Name:

DQ #2024000363

Colorado Department of Corrections

Vendor Name: _________________________________________________________________________

2. Where will the services under the contract, including any subcontracts, be performed?

List all county(ies) and state(s).

3. If it is anticipated that services under the contract or any subcontracts will be performed outside of the United States or the State of Colorado, explain why it is necessary or advantageous to go outside the Untied Stated or the State of Colorado to perform the contract or any subcontracts.

Signature Date

Printed Name Title