Attachment C_PERA Certification_AHEC-17922-R.pdf
PDF 8 KB Posted
- Attached to
- AHEC-17922-R - Transport Gas Contracting
- Solicitation number
- RFP GMAA 2017000272 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a PERA (Public Employees' Retirement Association) Certification and Affidavit form required for vendor compliance with Colorado state contracting regulations on contract AHEC-17922-R. The document serves as a attestation mechanism to ensure vendors meet specific requirements related to PERA retiree involvement in state contracts under Colorado Revised Statutes 24-51-1101(2), 24-51-401, and related provisions.
The certification requires vendors to disclose their relationship to PERA retirees across four distinct categories: individual retiree status, ownership percentage by PERA retirees (5% threshold), employment of PERA retirees in service delivery with percentage of contract dollars attributable to such employment, and business affiliation or profit from PERA retiree performance. Each section requires the vendor's authorized representative to certify under penalty of perjury which applicable condition exists for their organization. The document must be signed and dated by an authorized representative and include the vendor's full legal name and FEIN or Social Security Number to be considered valid for contract submission.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT C - AHEC-17922-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
File details come from the government source that posted it. Updated .