Exhibit 3 - Vendor Disclosure Statement Form.pdf
PDF 14 KB Posted
- Attached to
- NEJC15008 Vending Services
- Solicitation number
- DQ1 GJRA 2015000913 1
- Issued by
- Lincoln County, Colorado
About this file
This is a Vendor Disclosure Statement Form required by the State of Colorado under Colorado Revised Statute 24-102-206 for all state contracts and solicitations for services executed after August 3, 2007. The form applies to contracts where services may be performed outside the United States or Colorado and requires vendors to disclose the location of service performance, including any subcontracted work. Vendors must explain the necessity or advantage of performing work outside the United States or State of Colorado if applicable. The form requests the contract routing number and vendor name for tracking and identification purposes.
The disclosure requirement does not apply to contracts where 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). Vendors are required to complete and return the form to the contracting agency if information regarding contract performance location has not been disclosed in the Statement of Work.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit 1 - Purchase Order Terms & Conditions 1.1.09.pdf | ||
| Exhibit 4 - W9.pdf | ||
| NJC DQ 15008 Vending.pdf | ||
| Exhibit 2 - Special Provisions 1.1.09.pdf |
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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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