5. Exhibit D - Vendor Disclosure Stmt.pdf
PDF 114 KB Posted
- Attached to
- Tractor with Cab and Loader
- Solicitation number
- DQ 2025000492
- Issued by
- Lincoln County, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections for a state contract opportunity (Solicitation Number DQ 2025000492). The form is designed to gather information about where contract services will be performed, with specific focus on work locations both within and outside of the United States and Colorado. The disclosure is required prior to contracting and aims to provide transparency about potential service delivery locations.
The form exempts certain types of contracts from this disclosure requirement, including those related to Medicare, Colorado Medical Assistance, Children's Basic Health Plan, Colorado Indigent Care Program, and construction contracts. Vendors are required to list all counties and states where services will be performed, and if services are anticipated to be performed outside of the United States or Colorado, they must explain why such external performance is necessary or advantageous. The document provides space for vendor name, service locations, explanation of external service performance, and requires a signature, printed name, and title of the respondent.
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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 2025000492
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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