Appendix D - Service Disclosure Form.pdf
PDF 192 KB Posted
- Attached to
- John Deere AG OEM P@S
- Solicitation number
- IFB 26-027 RM
- Issued by
- Denver County, Denver City, Colorado
About this file
This document is a Service Disclosure Form from the Colorado Department of Transportation (CDOT) for an independent contractor engagement. The form requires a vendor to disclose details about services to be performed, including the percentage and monetary value of work done outside of Colorado and outside of the United States. The document includes a comprehensive questionnaire designed to determine the contractor's status as an independent entity, with multiple yes/no/not applicable questions covering aspects such as business registration, client diversity, work location, equipment provision, and operational independence.
The form seeks to clarify the contractor's business relationship with the state by probing into various operational characteristics, such as whether the state is the contractor's only client, if the contractor has its own place of business, determines its own work schedule, offers services to the general public, carries appropriate insurance, and has direct control over work performance. By collecting these details, CDOT aims to ensure proper classification of the contractor and compliance with state regulations regarding independent contractor status, specifically referencing Colorado Revised Statute 24-102-206 concerning contractor performance outside of Colorado or the United States.
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Other files
| File | Type | Posted |
|---|---|---|
| IFB 26-027 RM - John Deere AG P@S.pdf | ||
| Appendix B - Price Agreement Template.pdf | ||
| Appendix A, John Deer Ag OEM P_S.pdf |
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APPENDIX D - SERVICE DISCLOSURE
FORM
Vendor Disclosure Statement
In compliance the Contractor Performance Outside the United States or Colorado, CRS 24-102-206, the awarded Supplier is required to disclose information on where the services will be performed under this award.
Indicate percent and value of Services Performed:
Outside Colorado - ___________% $_________________ value
Outside United States - ___________% $_________________ value
Independent contractor information. Please select Yes, No, or NA (Not applicable) for each question.
mitchellrt Cross-Out
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State’s Office and/or the IRS to conduct business as
YES NA
Is the State the only client the contractor works with?
Is the contractor registered with the Secretary of
NO
an independent contractor?
Does the contractor have their own place of business?
Does the contractor hire retired state employees to perform the work?
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Does the contractor determine how and when the services will be performed?
Does the State provide the contractor with equipment, tools or materials to conduct the work?
Does the contractor have direct daily control over state employees?
workers’ compensation insurance?
Does the contractor bill by an hourly rate?
Does the contractor bill by a lump sum?
Is your company a sole proprietor?
Does the contractor have unemployment and
NA
Does the contractor offer services to the general public and have other clients?
Does the State control the route or location where the work must be performed?
Does the contractor need to be trained by the State to be able to provide the service?
Does the contractor work on state property?
YES NO
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