5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 149 KB Posted
- Attached to
- NCR Roll Stock Paper - CCi Print Shop
- Solicitation number
- DQ CFAA 2026000031
- Issued by
- Denver County, Denver City, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections, designed to capture information about potential contract performance locations for state contracts. The form requires vendors to disclose where services will be performed, including details about any work conducted outside of Colorado or the United States. Specifically, the form requires vendors to list all counties and states where contract services will be executed and provide an explanation if any services are anticipated to be performed outside of Colorado or the United States.
The form is part of the state's contract management process and includes several exemptions, notably that it does not apply to contracts related to Medicare, medical assistance, children's health plans, or construction contracts. Vendors must complete this disclosure statement prior to contracting or as part of a solicitation process, with the document serving as a transparency mechanism for the state to understand the geographic scope of potential service delivery. The form requires vendor signature, printed name, title, and date, and is associated with solicitation number DQ 2026, though specific details for that solicitation are not provided in this exhibit.
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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 2026__________________________________________________
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: _____________________________________
File details come from the government source that posted it. Updated .