Exhibit 3 - Vendor Disclosure Statement Form.pdf

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Attached to
NEJC18002 PIPE AND DRAPE SYSTEM
Solicitation number
DQ1 GJRA 2018000342 1
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, 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 their Statement of Work must complete and return this form to the contracting agency. If services are to be performed outside the specified geographic boundaries, the vendor must identify the specific countries and states where work will occur and provide a detailed explanation of why such performance is necessary or advantageous.

The disclosure requirement does not apply to contracts involving Medicare, the Colorado Medical Assistance Act, the Children's Basic Health Plan Act, or the Colorado Indigent Care Program. The form requires vendors to provide their name and the contract routing number for identification and tracking purposes. This mandatory disclosure mechanism ensures state oversight of contract performance locations and establishes a clear documentation process for any anticipated work performed beyond United States or Colorado borders.

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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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