Appendix E - Service Disclosure Form.pdf
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- Attached to
- ITS HVAC Parts & Services
- Solicitation number
- IFB 26-009 NM
- Issued by
- Denver County, Denver City, Colorado
About this file
The document is a Service Disclosure Form for Invitation for Bid (IFB) 26-009 NM issued by the Colorado Department of Transportation (CDOT) for ITS HVAC Parts & Services. This form is an appendix designed to collect detailed information about a potential contractor's independent status and service delivery characteristics.
The form requires vendors to disclose the percentage and monetary value of services performed outside of Colorado and the United States, and provides a comprehensive questionnaire to assess the contractor's operational independence. The checklist covers various aspects of the contractor's business model, including client diversity, business registration, employee hiring practices, service performance flexibility, insurance coverage, billing methods, and ownership structure. Vendors are expected to respond to each question with either "Yes", "No", or "NA" (Not Applicable), providing transparency about their business operations and relationship with the state of Colorado.
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IFB 26-009 NM Service Disclosure Form Page | 1 of 2
IFB 26-009 NM – ITS HVAC Parts & Services
APPENDIX E - 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.
YES NO NA
Is the State the only client the contractor works with?
Is the contractor registered with the Secretary of
State’s Office and/or the IRS to conduct business as an independent contractor?
Does the contractor hire retired state employees to perform the work?
Does the contractor have their own place of business?
IFB 26-009 NM Service Disclosure Form Page | 2 of 2
YES NO NA
Does the contractor offer services to the general public and have other clients?
Does the contractor need to be trained by the State to be able to provide the service?
Does the contractor determine how and when the services will be performed?
Does the contractor work on state property?
Does the State control the route or location where the work must be performed?
Does the State provide the contractor with equipment, tools or materials to conduct the work?
Does the contractor have unemployment and workers’ compensation insurance?
Does the contractor have direct daily control over state employees?
Is your company a sole proprietor?
Does the contractor bill by an hourly rate?
Does the contractor bill by a lump sum?
Indicate percent and value of Services Performed:
File details come from the government source that posted it. Updated .