Exhibit 3 - Vendor Disclosure Statement Form.pdf

This is a Vendor Disclosure Statement Form required by Colorado Revised Statute 24-102-206 for the state of Colorado regarding contract performance outside the United States or Colorado. The form applies to all state contracts and solicitations for services executed after August 3, 2007, and must be completed and returned to the contracting agency if vendor performance information has not been disclosed in the Statement of Work. The form requires vendors to disclose whether any services under the contract or subcontracts will be performed outside the United States or Colorado, and if so, to identify the specific countries and states where work will occur and explain the necessity or advantage of performing services outside the United States or Colorado.

The form is not required for contracts to which the State is a party under specific Colorado medical assistance programs, including those under the Medicare program, 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). Vendors must provide their name and the contract routing number when submitting the completed disclosure statement.