Attachment C - Outside Colorado or US Form 1-2009.doc

DOC document 433 KB Posted

Attached to
KAAA, 1221, Solicitation for AED's and Oxygen Inhalers
Solicitation number
DQ1 KAAA 2017000262 2
Issued by
Denver County, Denver City, Colorado

About this file

This is a vendor disclosure form issued by the Colorado Department of Labor and Employment, Procurement & Contract Services, required under Colorado Revised Statute 24-102-206. The form applies to all state contracts, including purchase orders and solicitations for services executed after August 3, 2007. Vendors and contractors must complete and return this attachment to the contracting agency prior to performing any work. The form requires vendors to disclose whether any services under the contract or subcontracts will be performed outside the United States or the State of Colorado.

If services are anticipated to be performed outside Colorado or the United States, the vendor must identify the specific country or state where services will be performed and provide a detailed explanation of why it is necessary or advantageous to conduct work outside these geographic boundaries. Completed forms must be submitted to the Colorado Department of Labor and Employment, Procurement and Contract Services, either by facsimile to 303-318-8068, by mail to 633 17th Street, Suite 1100, Denver, Colorado 80202-3660, or by email to cdle_purchasing@state.co.us. This disclosure requirement ensures state transparency regarding contract performance locations and allows the state to evaluate the justification for any out-of-state or international work.

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ATTACHMENT C

JOHN HICKENLOOPER

Governor

ELLEN GOLOMBEK

Executive Director

KRISTIN M. CORASH

Deputy Executive Director

DEPARTMENT OF LABOR AND EMPLOYMENT

PROCUREMENT & CONTRACT SERVICES

633 17th Street, Suite 1100

Denver, Colorado 80202-3631 Telephone: (303) 318-8067 FAX: (303) 318-8068

Vendor/Contractor:

Vendor/Contractor Signature:

Date:

Printed Name of Signor:

Contract/Purchase Order Number:

Vendor/CONTRACTOR Disclosure Statement

Contract Performance Outside the United States or Colorado

Colorado Revised Statute 24-102-206 To the extent the vendor and/or contractor has not disclosed the following information in the Statement of Work, this form shall be completed and returned to the contracting agency prior to the performance of work. This applies to all state contracts (including purchase orders) and solicitations for services executed after August 3, 2007.

1.

Are any services under the contract or any subcontracts anticipated to be performed outside the United States or the State of Colorado?

Yes

FORMCHECKBOX

No

FORMCHECKBOX

If “Yes,” please complete the following two questions:

2.

Where will the services be performed under the contract, including any subcontracts?

(List country(ies) and/or state(s).

3. Explain why it is necessary or advantageous to go outside of the United States or the State of Colorado to perform the contract or any subcontracts.

In part, C.R.S. 24-102-206 states:

(1) Prior to contracting or as a requirement for the solicitation of any contract from the state for services, as appropriate, any prospective vendor shall disclose in a statement of work where services will be performed under the contract, including any subcontracts, and whether any services under the contract or any subcontracts are anticipated to be performed outside the United States or the state. If the prospective vendor anticipates services under the contract or any subcontracts will be performed outside the United States or the state, the vendor shall provide in its statement of work a provision setting forth why it is necessary or advantageous to go outside the United States or the state to perform the contract or any subcontracts.

Prior to the performance of work, please fax or mail the completed form(s) to:

Colorado Department of Labor and Employment

Attention: Procurement and Contract Services

633 17th Street, Suite 1100, Denver, Colorado 80202-3660

Facsimile: 303-318-8068

E-mail: cdle_purchasing@state.co.us

Rev. 1-2009

File details come from the government source that posted it. Updated .