5. Exhibit E - Vendor Disclosure Stmt.pdf
PDF 388 KB Posted
- Attached to
- Hobby Items - Canteen
- Solicitation number
- DQ 2025000160
- Issued by
- Colorado
About this file
This document is a Vendor Disclosure Statement from the Colorado Department of Corrections (CDOC) for Contract Performance Outside of the United States of Colorado, associated with Solicitation Number DQ 2025000160. The form is designed to require prospective vendors to disclose details about where contract services will be performed, including any subcontracts. The disclosure is not required for certain types of contracts, including Medicare, medical assistance, children's health plans, indigent care programs, or construction contracts.
The form requires vendors to specify the counties and states where services will be performed and explain any anticipated work performed outside of the United States or Colorado. The document provides space for vendors to provide their name, location of services, justification for out-of-state work, and signature details. This disclosure is part of the state's contract management information process and appears to be a standard requirement for vendors seeking to contract with the Colorado Department of Corrections.
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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 2025000160
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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