6-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Solicitation number
- UDOT270026MP
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required by the Utah Department of Transportation (UDOT) Procurement Services in response to the UDOT Regional Welding and Fabrication Services Request for Proposals. The form requires vendors to provide certifications and disclosures regarding their eligibility and suitability to perform contract work. Vendors must confirm whether they have ever been debarred, suspended, proposed for debarment, or declared ineligible by any government department or agency at the international, national, state, or local level. Additionally, vendors must disclose any conflicts of interest or potential conflicts of interest that might arise during contract performance. The form also requires vendors to declare whether they have outstanding tax liens in the State of Utah. Responses must be submitted with detailed explanations if any answer to these certifications is affirmative.
The form includes a fourth certification requiring vendors to disclose any material information not already provided in their proposal that could impact the State's determination of the vendor's responsiveness for contract award. This includes legal actions, recent turnover in major personnel, loss of major contracts, or any alleged violations of federal, state, or local regulations, as referenced under Utah Code Annotated sections 63G-6a-120 and 902. Vendors must certify their compliance with all disclosed items, and any affirmative responses require accompanying statements explaining the circumstances. This certification form is a standard compliance requirement and must be completed as part of the overall proposal submission for the UDOT welding and fabrication services contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| 7-09. UDOT Map- 5 regions.pdf | ||
| 9-08. Sample Score Sheet.doc | DOC document | |
| 4-04. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 5-05. Submittal Form- Attachment A- Standard Terms and Conditions- Yes No.docx | DOCX document | |
| 8-10. Sample Blueprint.pdf | ||
| 2-02. Scope of Work and Associated Requirements.doc | DOC document | |
| 10-06. Submittal Form- Pricing Form.doc | DOC document | |
| 3-03. Submittal Form- Vendor Setup Form.pdf | ||
| 1-01. RFP General Information.doc | DOC document |
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Text version
Certifications- Debarment, Conflict of Interest, Outstanding Tax Lien, Other Information
1. DEBARMENT- Is vendor presently or has vendor ever been debarred, suspended, proposed for debarment, or declared ineligible by any government department or agency, whether international, national, state, or local? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I have not been debarred, suspended, proposed for debarment, or declared ineligible.
Yes, I am or have been debarred, suspended, proposed for debarment, or declared ineligible (see as follows):
2. CONFLICT OF INTEREST- Does Vendor have any conflict, or potential conflict of interest, that might arise during the contract? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have any Conflict or Potential Conflict of Interest.
Yes, I do have a Conflict or Potential Conflict of Interest (see as follows):
3. OUTSTANDING TAX LIEN- Does vendor have an outstanding tax lien in the State of Utah? If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have an outstanding Tax Lien.
Yes, I do have an outstanding Tax Lien (see circumstances as follows):
4. OTHER INFORMATION- Does vendor have any information that is not already provided within its proposal that if known to the State would impact the State’s determination on vendor's responsiveness for a contract award (i.e., legal action, recent turn-over in major personnel, loss of a major contract, any alleged violations of federal, state or local regulations, etc.). Please see UCA 63G-6a-120 & 902. If answer is "Yes", vendor must provide a statement explaining the circumstances.
No, I do not have any Other Information.
Yes, I do have Other Information (see as follows):
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