5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 149 KB Posted
- Solicitation number
- DQ CAAA 2026000103
- Issued by
- El Paso County, Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections, specifically Exhibit E, which requires prospective vendors to disclose information about contract performance locations. The form is designed to be completed prior to contracting or during the solicitation of services from the State of Colorado, with specific exemptions for certain types of contracts including Medicare, medical assistance, children's health plans, and construction contracts. The document seeks detailed information about where contracted services will be performed, including counties and states, and requires an explanation if services are anticipated to be performed outside of the United States or Colorado.
The disclosure form is structured to capture key vendor information, including the solicitation number (DQ 2026), vendor name, service performance locations, and rationale for performing services outside of the United States or Colorado. Vendors are instructed to complete the form comprehensively, with space provided for listing counties and states of service performance and explaining any out-of-state or out-of-country service arrangements. The form requires a signature, printed name, and title of the vendor representative, indicating an official commitment to the disclosed information.
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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 .