Exhibit 3 - Vendor Disclosure Statement Form.pdf

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Attached to
NEJC15010 Residence Hall Furniture
Solicitation number
DQ1 GJRA 2015001174 2
Issued by
Lincoln County, Colorado

About this file

This is a Vendor Disclosure Statement Form issued by the State of Colorado on January 24, 2008, pursuant to Colorado Revised Statute 24-102-206. The form applies to all state contracts and solicitations for services executed after August 3, 2007, and requires vendors to disclose whether any services under the contract or subcontracts will be performed outside the United States or Colorado. If services are planned for performance outside these jurisdictions, 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 requests the contract routing number and vendor name for documentation purposes.

The disclosure requirement does not apply to contracts to which the State is a party under Medicare, the Colorado Medical Assistance Act (Articles 4 to 6 of Title 25.5 CRS), the Children's Basic Health Plan Act (Article 8 of Title 25.5 CRS), or the Colorado Indigent Care Program (Part I of Article 4 of Title 25.5 CRS). This form serves as a compliance mechanism to ensure transparency regarding the geographic location of contract performance and to maintain state control over service delivery under Colorado procurement regulations.

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Text version

January 24, 2008

VENDOR DISCLOSURE STATEMENT

Contract Performance Outside the United States or Colorado

Colorado Revised Statute 24-102-206

To the extent the vendor has not disclosed the following information in the Statement of Work, this form shall be completed and returned to the contracting agency. This applies to all state contracts and solicitation 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 Colorado?

Yes No

If “Yes”, please complete the following three 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.

4. Contract Routing Number:

Vendor Name:

Not required for contracts to which the State is a party under:

• Medicare

• The “Colorado Medical Assistance Act”, Articles 4 to 6 of Title 25.5 CRS

• The “Children/s Basic Health Plan Act”, Article 8 of Title 25.5, CRS

• The “Colorado Indigent Care Program”, Part I of Article 4 of Title 25.5, CRS

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