6-07. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Solicitation number
- UDOT270026MP-1
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required by the Utah Department of Transportation (UDOT) in response to its Request for Proposals for Regional Welding and Fabrication Services. The form serves as a compliance document for vendors bidding on UDOT contracts and requires vendors to attest to their eligibility and disclosure of any material information that could affect their responsiveness for contract award. The solicitation anticipates multiple contract awards and mandates that all contractors comply with UDOT's standards and specifications for welding and fabrication services.
The certification form contains four mandatory disclosure sections: debarment status, conflict of interest, outstanding tax liens in Utah, and other material information such as legal actions, personnel changes, loss of major contracts, or alleged violations of federal, state, or local regulations. Vendors must respond affirmatively or negatively to each section and provide written explanations for any "Yes" responses. These certifications are required under Utah Code Annotated sections 63G-6a-120 and 902 and are essential prerequisites for vendor qualification and contract award eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| 9-08. Sample Score Sheet.doc | DOC document | |
| 1-01. RFP General Information.doc | DOC document | |
| 10-06. Submittal Form- Pricing Form.doc | DOC document | |
| 2-02. Scope of Work and Associated Requirements.doc | DOC document | |
| 7-09. UDOT Map- 5 regions.pdf | ||
| 5-05. Submittal Form- Attachment A- Standard Terms and Conditions- Yes No.docx | DOCX document | |
| 8-10. Sample Blueprint.pdf | ||
| 3-03. Submittal Form- Vendor Setup Form.pdf | ||
| 4-04. Submittal Form- Business Confidentiality- Yes No.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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