5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 114 KB Posted
- Attached to
- Microwave Ovens
- Solicitation number
- DQ 2025000495
- Issued by
- Garfield County, Colorado
About this file
The document is an Exhibit E Vendor Disclosure Statement from the Colorado Department of Corrections for a solicitation (Number DQ 2025000495) related to a contract opportunity for microwave ovens. The form requires prospective vendors to disclose information about where contract services will be performed, with specific attention to work conducted outside of the United States or Colorado. The form is designed to provide transparency about the geographical locations where contract work and potential subcontracts might occur.
The disclosure statement includes several key exemptions, noting that it is not required for contracts under Medicare, certain medical assistance programs, or construction contracts. Vendors are instructed to complete the form if the requested information has not been previously disclosed, returning it to the contracting state agency. The form requires vendors to list the counties and states where services will be performed and explain any necessity or advantage of performing work outside the United States or Colorado. Signatures, printed names, and titles are required to validate the disclosure.
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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 2025000495
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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