Attachment 4 - Vendor Disclosure Statement.doc

This is a Vendor Disclosure Statement form required by the State of Colorado pursuant to Colorado Revised Statute 24-102-206, applicable to contract opportunity DQ1-AADA 2016-1682. The form requires vendors to disclose whether any services under the contract or related subcontracts will be performed outside the United States or Colorado. If services are anticipated to be performed outside these geographic boundaries, vendors must identify the specific countries and states where work will occur and provide justification for performing services outside the United States or Colorado. The form applies to all state contracts and solicitations for services executed after August 3, 2007, and must be completed and returned to the contracting agency.

The disclosure requirement does not apply to contracts under Medicare, the Colorado Medical Assistance Act, the Children's Basic Health Plan Act, or the Colorado Indigent Care Program. Vendors are required to provide their name, the contract routing number, and complete responses to all applicable questions before submission. The form serves as a transparency mechanism to ensure the state government maintains visibility into outsourced work performed under state contracts and understands the operational necessity for any offshore or out-of-state performance.