9-09. Submittal Form- Certifications- Yes No.docx
DOCX document 19 KB Posted
- Solicitation number
- UDOT260084MP-1 - Re solicitation
- Issued by
- Utah
About this file
This is a Submittal Form for Certifications required by the Utah Department of Transportation (UDOT) for vendors responding to the Fiber Optic and ATMS Construction Services RFP. The form addresses four critical certification areas: debarment status, conflict of interest disclosures, outstanding tax liens in Utah, and any other material information that could impact the State's assessment of vendor responsiveness. Vendors must affirmatively declare whether they have been debarred, suspended, proposed for debarment, or declared ineligible by any government entity; whether conflicts of interest exist or could arise during contract performance; whether outstanding tax liens exist within Utah; and whether any other circumstances such as legal actions, personnel changes, contract losses, or alleged regulatory violations should be disclosed to the State. Any affirmative responses require vendors to provide detailed explanatory statements regarding the circumstances.
The certification form is a mandatory submittal requirement for all vendors seeking to be considered for contract award under the UDOT RFP, which anticipates multiple contract awards for fast-turnaround construction services on a line-item pricing and payment basis. Vendors must comply with all UDOT standards and specifications for the work. The contract period extends through March 31, 2028, with no renewal options available. This form serves as a critical compliance mechanism to ensure that only responsive and responsible vendors are eligible for consideration, requiring complete honesty and transparency from all prospective contractors regarding their business standing and any circumstances that could affect contract performance.
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Other files
| File | Type | Posted |
|---|---|---|
| 11-06. Submittal Form- Vendor Setup Form.pdf | ||
| 7-04. Delineator Std Specification.pdf | ||
| 3-07. Submittal Form- Business Confidentiality- Yes No.doc | DOC document | |
| 6-03. Items Listing MP Revision.docx | DOCX document | |
| 4-11. Map- Regional Map- UDOT Fiber RFP Region 4 Split.pdf | ||
| 5-10. Sample Score Sheet.doc | DOC document | |
| 10-02. Scope of Work.doc | DOC document | |
| 1-05. Submittal Form- Pricing- All Regions.xlsx | XLSX spreadsheet | |
| 2-08. Submittal Form- Attachment A- Standard Terms and Conditions- Yes No.docx | DOCX document | |
| 8-01. RFP General Information- IN LIEU OF.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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