5. Exhibit D - Vendor Disclosure Stmt.pdf
PDF 114 KB Posted
- Attached to
- Bakery Oven - CTCF
- Solicitation number
- DQ 2025000213
- Issued by
- Garfield County, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections for a state contract solicitation (Solicitation Number: DQ 2025000213). The form is designed to capture information about where contract services will be performed, with a specific focus on disclosing any work anticipated to be conducted outside of the United States or the State of Colorado. Vendors are required to complete this statement prior to contracting, with exceptions noted for certain types of contracts such as those under Medicare, medical assistance programs, and construction contracts.
The disclosure form requires vendors to provide details about the geographic locations where contract services will be performed, including all counties and states involved. If services are expected to be performed outside of the United States or Colorado, vendors must explain why such external performance is necessary or advantageous. The document includes space for the vendor's name, signature, date, printed name, and title, serving as a transparent mechanism for the Colorado Department of Corrections to understand the full scope of potential contract service delivery.
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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 2025000213
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: _____________________________________
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