Attachment B_AHEC-15909-R_PERA Certification.pdf
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- Solicitation number
- RFP GMAA 2015000072 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Certification and Affidavit form (Attachment B) for AHEC-15909-R related to Public Employees' Retirement Association (PERA) retiree compliance requirements in Colorado. The document requires vendors to certify their status regarding PERA retirees under Colorado Revised Statutes, specifically sections 24-51-1101(2) and 24-51-401. Vendors must declare whether they are PERA retirees themselves (if sole proprietors or individuals), whether PERA retirees own 5% or more of the company, whether the company employs PERA retirees performing state contract services (and if so, the percentage of contract value attributable to such employees), and whether the company is affiliated with or profits from services performed by PERA retirees. The certification must be sworn or affirmed under penalty of perjury under Colorado law.
The form requires completion by an authorized representative of the vendor, including the vendor's full legal name, FEIN or Social Security Number, signature, and title, along with the certification date. This affidavit serves as a compliance mechanism to ensure vendors meet Colorado's statutory requirements regarding PERA retiree involvement in state contracts. The form does not address pricing, project scope, or specific deliverables, as it functions solely as a regulatory certification document required as part of the vendor qualification and contracting process.
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Other files
| File | Type | Posted |
|---|---|---|
| Appendix A_Basic Functional Requirements.docx | DOCX document | |
| Attachment A_AHEC Model Contract.pdf | ||
| Appendix B_Interface Summary.pdf | ||
| AHEC-15909-R_Questions and Answers_FINAL.pdf | ||
| AHEC-15909-R_AHEC ERP_FINAL.docx | DOCX document | |
| Attachment C_AHEC-15909-R_W-9.pdf |
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Text version
Attachment B AHEC-15909-R
CERTIFICATION AND AFFIDAVIT
REGARDING PERA RETIREES
The Vendor, whose name and signature appear below, certifies and agrees as follows:
1. If the Vendor is a sole proprietor or individual, the undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):
____ I am a PERA retiree, or
____ I am not a PERA retiree
2. The Vendor shall comply with the provisions of 24-51-1101(2) C.R.S. The undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):
____ A PERA retiree owns 5% or more of the company, or
____ A PERA retiree owns less than 5% of the company, or
____ No percentage of the company is owned by a PERA retiree
3. The Vendor shall comply with the provisions of 24-51-401 C.R.S. The undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):
____ The company employs a PERA retiree and is under agreement to perform a service with the state agency. If this is the case, than _________ percentage of the total dollar amount of the contract is attributable to PERA retiree. Or
____ The company does not employ a PERA retiree and is under agreement to perform a service with the state agency
4. The Vendor shall comply with the provisions of 24-51-1101(2). The undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):
____ The company is affiliated with and profits from the performance of services by a PERA retiree, or
____ The company is not affiliated with and does not profit from the performance of services by a PERA retiree
CERTIFIED and AGREED to this _____ day of __________________, 200__.
VENDOR:
(Vendor Full Legal Name) (FEIN or Social Security Number)
BY: _____________________________ ____________________
Signature of Authorized Representative Title
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