5. Exhibit D - Vendor Disclosure Stmt.pdf
PDF 192 KB Posted
- Attached to
- Washing Machines - FCF
- Solicitation number
- DQ 2025000373
- Issued by
- Garfield County, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections for solicitation number DQ 2025000373, which relates to a contract for washing machines at the Fremont Correctional Facility. The form requires prospective vendors to disclose details about where services will be performed, including any work done outside of Colorado or the United States. The form is specifically designed to capture information about the geographic locations of contract and subcontract work.
The disclosure statement is not required for certain types of contracts, including those related to Medicare, medical assistance, children's health plans, or construction contracts. Vendors are instructed to complete the form by listing all counties and states where services will be performed, and provide an explanation if any work is anticipated to occur outside of the United States or Colorado. The form requires the vendor's signature, printed name, and title, and is part of the procurement process for the washing machine procurement at the correctional facility.
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Text version
Exhibit D
Colorado Department of Corrections
State of Colorado – Contract Management Information
Vendor Disclosure Statement
Contract Performance Outside of the United States of 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 Plan Act”, Article 8 of Title 25.5, C.R.S, or the “Colorado Indigent Care Program”, Part 1 of Article 3 of
Title 25.5 C.R.S.
• This Disclosure Statement is not required for Construction contract.
1. Solicitation Number: DQ 2025000373
2. Vendor Name:_____________________________________________________________________
3. Where will the services under the contract, including any subcontracts, be performed? List all county(ies) and state(s).
4. 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 United States or the State of Colorado to perform the contract or any subcontracts.
Signature: __________________________________ Date:_____________________________________
Printed Name: ______________________________ Title: _____________________________________
File details come from the government source that posted it. Updated .