Exhibit 3 - Vendor Disclosure Statement Form.pdf
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- Solicitation number
- IFB1 GJRA 2018000235 2
- 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 the state is a party and requires vendors to disclose whether any services under the contract or subcontracts will be performed outside the United States or Colorado. If work is anticipated outside these geographic boundaries, vendors must identify the specific countries and states where services will be performed and provide justification for performing work outside the United States or Colorado. The form requires the vendor name and contract routing number to be completed.
The disclosure requirement 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. This form serves as a compliance mechanism to ensure transparency regarding offshore or out-of-state work performance and allows the contracting agency to evaluate the necessity and appropriateness of work being performed outside Colorado's 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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