6-10. Submittal Form- Debarment or Suspension, Conflicts, Tax Lien, Responsiveness.docx
DOCX document 19 KB Posted
- Attached to
- UDOT RFP- C-V2X and Related Equipment
- Solicitation number
- UDOT260241MP formerly UDOT260084MP
- Issued by
- Utah
About this file
This is a certification and submittal form for debarment, conflicts of interest, tax liens, and responsiveness requirements issued by the Utah Department of Transportation (UDOT) Procurement Services in connection with their Request for Proposals for C-V2X and related equipment. The form requires vendors to certify their eligibility and provide disclosures regarding their business status and any potential issues that could affect their responsiveness for contract award. Vendors must answer four primary certification questions: whether they have been debarred, suspended, proposed for debarment, or declared ineligible by any government department or agency; whether they have any conflict of interest or potential conflict of interest that might arise during contract performance; whether they have an outstanding tax lien in the State of Utah; and whether they have any other material information not included in their proposal that could impact the State's determination of their responsiveness. The UDOT RFP anticipates multiple contract awards from qualified firms to provide C-V2X and related equipment in compliance with Utah Department of Transportation standards and specifications.
All vendors submitting proposals in response to this solicitation must complete this certification form and provide detailed written explanations for any "Yes" answers to the four certification questions. This form serves as a critical responsiveness requirement and must be submitted as part of the vendor's proposal package. References to Utah Code Annotated sections 63G-6a-120 and 902 establish the statutory framework governing these certifications and the State's right to evaluate vendor qualifications and any factors that could affect contract award decisions.
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Other files
| File | Type | Posted |
|---|---|---|
| 8-02. Scope of Work- UDOT V2X Hardware RFP Intro.docx | DOCX document | |
| 5-01. RFP General Information.doc | DOC document | |
| 10-07. Submittal Form- Vendor Setup Form.pdf | ||
| 9-06. CTW TIM Definitions.pdf | ||
| 7-08. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 1-05. Connected Vehicle Traveler Information Message Guidelines.docx | DOCX document | |
| 4-09. Submittal Form- Attachment A- Standard Terms and Conditions- Yes No.docx | DOCX document | |
| 3-04. Submittal Form- UDOT V2X Hardware RFP Cost Proposal Sheets.docx | DOCX document | |
| 2-03. Submittal Form- UDOT V2X Hardware RFP Response Sheets.docx | DOCX 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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