5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 119 KB Posted
- Attached to
- Correctional Facility Mattresses - CCi
- Solicitation number
- DQ1 CFAA 2026000107 2
- Issued by
- Garfield County, Colorado
About this file
This is a Vendor Disclosure Statement form issued by the Colorado Department of Corrections for state contract solicitation DQ 2026000107 regarding Correctional Facility Mattresses. The form requires prospective vendors to disclose the locations where contract services, including any subcontracts, will be performed by listing all relevant counties and states. Vendors must complete and return this disclosure statement to the contracting state agency prior to or as a requirement of the solicitation process.
The disclosure statement applies to all contracts for services from 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. If services are anticipated to be performed outside the United States or the State of Colorado, vendors must provide a detailed explanation of why such out-of-state or international performance is necessary or advantageous. The form requires vendor name, signature, printed name, title, and date of completion from the authorized representative.
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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 2026000107
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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