Exhibit 3 - Vendor Disclosure Statement Form.pdf

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Attached to
NEJC15012-1506M01-Dowis Hall Domestic Hot Water Heater Repl.
Solicitation number
DQ1 GJRA 2015001456 2
Issued by
Lincoln County, Colorado

About this file

This is a Vendor Disclosure Statement Form established under Colorado Revised Statute 24-102-206, applicable to all state contracts and solicitations for services executed after August 3, 2007. The form requires vendors to disclose whether any services under a contract or subcontracts will be performed outside the United States or Colorado. If work is anticipated outside these jurisdictions, vendors must identify the specific countries and states where services will be performed, explain the necessity or advantage of performing work outside the United States or Colorado, and provide the contract routing number and vendor name. The form applies to most state contracts, though it does not apply to contracts related to Medicare, the Colorado Medical Assistance Act, the Children's Basic Health Plan Act, or the Colorado Indigent Care Program.

The disclosure requirement ensures transparency regarding offshore or out-of-state service delivery and allows the contracting agency to evaluate the feasibility and appropriateness of external performance locations. Vendors must complete and return the form to the contracting agency if relevant information has not already been disclosed in the Statement of Work, ensuring that all parties understand the geographic scope of contract performance before execution.

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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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