5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 524 KB Posted
- Attached to
- Electronics & Small Appliances - Canteen
- Solicitation number
- DQ 2025000175
- Issued by
- Garfield County, Colorado
About this file
Exhibit E is a Vendor Disclosure Statement form from the Colorado Department of Corrections (CDOC) related to a contract for Electronics & Small Appliances for the Canteen Services program. The document requires prospective vendors to disclose the locations where contract services will be performed, including any work performed outside of Colorado or the United States. The form is specifically for solicitation number DQ 2025000175 and is part of the contract management information process for the state agency.
The disclosure statement has specific exemptions, including contracts under Medicare, Colorado Medical Assistance Act, Children Basic Health Plan Act, Colorado Indigent Care Program, and construction contracts. Vendors must complete the form by providing details about their service locations, and if any services are anticipated to be performed outside of Colorado or the United States, they must explain why such external performance is necessary or advantageous. The form requires the vendor's signature, printed name, and title to certify the accuracy of 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 2025000175
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 .