5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 106 KB Posted
- Attached to
- CDOC Warehouse Fresh Produce Order
- Solicitation number
- DQ CAAA 2025000245
- Issued by
- Garfield County, Colorado
About this file
This document is a Vendor Disclosure Statement for the Colorado Department of Corrections, designed to gather information about contract performance locations. The form requires prospective vendors to disclose where services will be performed, including any subcontracts, and to explain if services will be conducted outside of the United States or Colorado. The document specifically notes that this disclosure is not required for certain types of contracts, including those related to Medicare, medical assistance, children's health plans, and construction contracts.
The form provides spaces for vendors to list the solicitation number (DQ 2025), vendor name, specific counties and states where services will be performed, and a section for explaining why services might need to be performed outside of the United States or Colorado. The document requires a signature, printed name, and title from the vendor, serving as an official disclosure mechanism for the state's contract management process. This form appears to be part of the procurement documentation for the CDOC Warehouse Fresh Produce Order, ensuring transparency in the vendor's operational locations and potential international or out-of-state service delivery.
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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 2025__________________________________________________
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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