Exhibit 3 - Vendor Disclosure Statement Form.pdf

This is a Vendor Disclosure Statement Form issued by the State of Colorado on January 24, 2008, in compliance with 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. Vendors who have not already provided this information in the Statement of Work must complete and return the form to the contracting agency. If services are to be performed outside the specified jurisdictions, vendors must identify the country or state where work will occur and explain the necessity or advantage of performing services outside the United States or Colorado.

The disclosure requirement does not apply to contracts under specific Colorado health programs, including Medicare, the Colorado Medical Assistance Act (Articles 4-6 of Title 25.5 CRS), the Children's Basic Health Plan Act (Article 8 of Title 25.5 CRS), and the Colorado Indigent Care Program (Part I of Article 4 of Title 25.5 CRS). The form requires vendors to provide their name and the contract routing number for identification and tracking purposes.