7-07. Submittal Form- Certifications- Yes No.docx

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Attached to
UDOT IFB- Mobile Crane etc Training, Testing, and Certification
Solicitation number
UDOT270015MP
Issued by
Utah

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Summary

This is a Submittal Form - Certifications document for the Utah Department of Transportation (UDOT) Invitation for Bid (IFB) for Mobile Crane Operator, Digger Derrick, Service Truck Crane, Boom Truck Operator, Signalperson, Rigger, and Overhead Crane Training, Testing, and Certification services. The solicitation seeks a single provider capable of delivering comprehensive training, testing, and certification programs across multiple crane and rigging disciplines in accordance with specifications outlined in the solicitation documents. Bidders are required to complete this certification form and provide sufficient documentation and information to demonstrate full compliance with all stated specifications and requirements throughout their proposal submission.

This form serves as a critical compliance document within the bidding process, functioning as a yes/no certification checklist that allows bidders to formally attest to their ability to meet the solicitation's requirements. The document is issued under the authority of the Utah Procurement Code and applicable Utah Administrative Code provisions, with any conflicting provisions resolved in favor of statutory and regulatory requirements. Completion and submission of this form, along with supporting documentation, is mandatory for bidder consideration and contract award eligibility under this state procurement process.

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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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