Exhibit 3 - Vendor Disclosure Statement Form.pdf

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Attached to
NEJC DQ-18008 Williams Residence Hall Doors
Solicitation number
DQ1 GJRA 2018000870 2
Issued by
Lincoln County, Colorado

About this file

This is a Vendor Disclosure Statement Form required by Colorado Revised Statute 24-102-206 for the State of Colorado, applicable to all state contracts and solicitations for services executed after August 3, 2007. The form requires vendors to disclose whether any services under the contract or subcontracts will be performed outside the United States or Colorado. If services are to be performed outside these jurisdictions, vendors must identify the specific countries and/or states where work will occur and provide justification for performing services outside the United States or Colorado.

The form applies to all state contracts except those involving Medicare, the Colorado Medical Assistance Act, the Children's Basic Health Plan Act, or the Colorado Indigent Care Program. Vendors must complete the disclosure form and return it to the contracting agency, providing their name, the contract routing number, and responses to all applicable questions regarding out-of-state or international performance.

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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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