5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 479 KB Posted
- Attached to
- Household Items - Canteen
- Solicitation number
- DQ 2025000174
- Issued by
- Colorado
About this file
Exhibit E is a Vendor Disclosure Statement form from the Colorado Department of Corrections for the Solicitation Number DQ 2025000174. The document is a standard state procurement form requiring vendors to disclose information about where contract services will be performed, particularly if any work is anticipated to occur outside of the United States or Colorado. The form is part of the state's contract management process and must be completed prior to contracting for services.
The specific disclosure requirements include identifying the vendor's name, listing all counties and states where services will be performed, and providing an explanation if any services are expected to be performed outside of the United States or Colorado. The form notes that disclosure is not required for certain types of contracts, including those related to Medicare, medical assistance, children's health plans, and construction contracts. The document provides space for the vendor's signature, printed name, and title, enabling transparency in the state's procurement process.
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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 2025000174
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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