Appendix C. UI Formdocx.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP EGBA 2016000096 6
- Issued by
- Denver County, Denver City, Colorado
About this file
This document is a Certification and Affidavit form required by the State of Colorado Office of the State Architect for the Public Safety Communications Network Microwave Infrastructure Replacement project (Project No. 2016011P15), administered through the Governor's Office of Information Technology. The form establishes compliance requirements for vendors entering into contracts with the State of Colorado and mandates adherence to federal and state employment eligibility verification standards.
The certification requires vendors to comply with Colorado Revised Statutes 8-17.5-101 and 8-17.5-102, which prohibit knowingly employing or contracting with unauthorized immigrants to perform work for the State. Vendors must certify that they do not currently employ unauthorized immigrants and must participate in either the E-Verify Program (jointly administered by the U.S. Department of Homeland Security and Social Security Administration) or the Department Program administered by the Colorado Department of Labor and Employment to verify employment eligibility of all newly hired employees. Vendors must also comply with all reasonable investigative requests from the Colorado Department of Labor and Employment. For sole proprietors, the affidavit requires a sworn statement under penalty of perjury confirming U.S. citizenship, permanent residency, or lawful presence in the United States, with acknowledgment that false statements constitute perjury under Colorado law. Non-compliance with these provisions allows the State to terminate the contract for breach and pursue damages against the vendor.
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Other files
| File | Type | Posted |
|---|---|---|
| Bid Bond.doc | DOC document | |
| RFP 2016000096 FINAL.docx | DOCX document | |
| Appendix F budget.docx | DOCX document | |
| Appendix D8 Cost Proposal Forms .xlsx | XLSX spreadsheet | |
| LMBond.doc | DOC document | |
| Appendix E Building codes.doc | DOC document | |
| Appendix A1-2.docx | DOCX document | |
| Appendix B2 SC8.1.doc | DOC document | |
| Appendix D1- Non Disclosure Agreement .docx | DOCX document | |
| Appendix D8 1COST PROPOSAL Summary.docx | DOCX document | |
| Appendix D Specifications.docx | DOCX document | |
| RFP 2016000096 REVISED 1-14.docx | DOCX document | |
| Appendix D9 Compliance Matrix.xlsx | XLSX spreadsheet | |
| MW Q_A final.docx | DOCX document | |
| Appendix D8 Pricing Instructions.docx | DOCX document | |
| Appendix B1 Sc 8.0.docx | DOCX document | |
| Authorization to Bid.doc | DOC document | |
| FINAL Round 2 QA.docx | DOCX document | |
| PerfBond.doc | DOC document |
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Appendix C
CERTIFICATION AND AFFIDAVIT REGARDING UNAUTHORIZED IMMIGRANTS (FORM UI-1)
STATE OF COLORADO
OFFICE OF THE STATE ARCHITECT
STATE BUILDINGS PROGRAMS
CERTIFICATION AND AFFIDAVIT REGARDING UNAUTHORIZED IMMIGRANTS
| Institution/Agency: |
| The Governor’s Office of Information Technology |
| Project No./Name: |
| 2016011P15 Public Safety Communications Network Microwave Infrastructure Replacement |
A. CERTIFICATION STATEMENT CRS 8-17.5-101 & 102 (HB 06-1343, SB 08-193)
The Vendor, whose name and signature appear below, certifies and agrees as follows:
1. The Vendor shall comply with the provisions of CRS 8-17.5-101 et seq. The Vendor shall not knowingly employ or contract with an unauthorized immigrant to perform work for the State or enter into a contract with a subcontractor that knowingly employs or contracts with an unauthorized immigrant.
2. The Vendor certifies that it does not now knowing employ or contract with and unauthorized immigrant who will perform work under this contract, and that it will participate in either (i) the “E-Verify Program”, jointly administered by the United States Department of Homeland Security and the Social Security Administration, or (ii) the “Department Program” administered by the Colorado Department of Labor and Employment in order to confirm the employment eligibility of all employees who are newly hired to perform work under this contract.
3. The Vendor shall comply with all reasonable requests made in the course of an investigation under CRS 8-17.5-102 by the Colorado Department of Labor and Employment. If the Vendor fails to comply with any requirement of this provision or CRS 8-17.5-101 et seq., the State may terminate work for breach and the Vendor shall be liable for damages to the State.
B. AFFIDAVIT CRS 24-76.5-101 (HB 06S-1023)
4. If the Vendor is a sole proprietor, the undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):
|_| I am a United States citizen, or
|_| I am a Permanent Resident of the United States, or
|_| I am lawfully present in the United States pursuant to Federal law.
I understand that this sworn statement is required by law because I am a sole proprietor entering into a contract to perform work for the State of Colorado. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to starting work for the State. I further acknowledge that I will comply with the requirements of CRS 24-76.5-101 et seq. and will produce the required form of identification prior to starting work. I acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under CRS 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
CERTIFIED and AGREED to this _ ____ day of ___ ___, _20 __.
VENDOR:
Vendor Full Legal Name
BY:
IPD D/B LS RFP
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