5. Exhibit D - Vendor Disclosure Stmt.pdf
PDF 122 KB Posted
- Attached to
- Manufacturing Space - CCi
- Solicitation number
- 2026000001
- Issued by
- Custer County, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections for Solicitation Number DQ 2026000001, which requires prospective vendors to disclose information about contract performance locations. The form is designed to capture details about where services will be performed, including any subcontractors, with a specific focus on work performed outside of the United States or the State of Colorado.
The disclosure statement is not mandatory for certain types of contracts, including those related to Medicare, Colorado Medical Assistance, Children's Basic Health Plan, Colorado Indigent Care Program, or construction contracts. Vendors are required to provide information about the counties and states where services will be performed, and if any work is anticipated to occur outside of Colorado or the United States, they must explain why such external performance is necessary or advantageous. The form requires the vendor's signature, printed name, and title to validate the disclosure.
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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 2026000001
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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