5. Exhibit E - Vendor Disclosure Stmt ADA.pdf
PDF 118 KB Posted
- Solicitation number
- IFB1 CFAA 2026000174 1
- Issued by
- Garfield County, Colorado
About this file
This is a Vendor Disclosure Statement form issued by the Colorado Department of Corrections for state and local contract opportunities in Colorado. The form is required for prospective vendors prior to contracting or as a solicitation requirement for any services contract with the State of Colorado, with specific exemptions for Medicare, Colorado Medical Assistance Act programs, Children Basic Health Plan Act programs, Colorado Indigent Care Program contracts, and construction contracts.
The form requires vendors to complete and return a disclosure statement identifying the solicitation number, vendor name, and all counties and states where contract services, including any subcontract work, will be performed. If services are anticipated to be performed outside the United States or State of Colorado, vendors must provide written explanation of the necessity or advantage of performing work outside these jurisdictions. The completed form must be signed and dated by an authorized representative with printed name and title. For the related contract opportunity regarding Center Pivot Irrigation System #2 in Colorado, vendors bidding on this invitation for bid would be required to submit this disclosure statement as part of their proposal package.
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Text version
Exhibit E
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 # __________________________________________________________
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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