Exhibit-5 DOC-2818 Contractor Compliance Form.docx
DOCX document 26 KB Posted
- Contract number
- 410036-M20-CJO7250-00
- Issued by
- Wisconsin
About this file
This is a Contractor Compliance Agreement form (DOC-2818) issued by the Wisconsin Department of Corrections Division of Management Services. The form serves as a standardized compliance verification document that contractors providing services to the Wisconsin Department of Corrections must complete and submit to ensure adherence to contract terms and conditions, particularly regarding background check requirements for contractor staff and applicants.
The document does not specify particular goods or services but rather establishes a compliance framework for all contractors working with the Wisconsin Department of Corrections. Contractors must affirm their commitment to provide services consistent with DOC contract requirements and comply with background check provisions for all staff and applicants. The compliance agreement covers all contracts a contractor holds with the DOC for a twelve-month period from the signature date, eliminating the need for separate forms when entering additional contracts during this timeframe. Contractors are required to renew their compliance verification annually by submitting a new signed form within twelve months of the original signature date or within 30 days of each contract year-end date, whichever occurs earlier.
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Text version
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Management Services DOC-2818 (Rev. 8/2018)
CONTRACTOR COMPLIANCE AGREEMENT
INSTRUCTIONS: Complete entire form and return to the Department of Corrections Purchasing Services, Contract Manager or the Purchasing Helpdesk, email address listed below.
| CONTRACTOR NAME: |
|_| CONTRACT COMPLIANCE
The contractor hereby agrees that as a contractor who provides services to the State of Wisconsin Department of Corrections (DOC), they will ensure that the contractor and all contractor staff shall provide any and all contracted services in a manner consistent with each DOC contract.
|_| CONTRACTOR STAFF & APPLICANT BACKGROUND CHECKS
Furthermore, the contractor affirms compliance with all Contract Terms and Conditions concerning all provisions relating to background checks of all contractor staff and applicants.
Authorized Contractor Representative Information:
| NAME |
| POSITION TITLE |
| CONTRACTOR ADDRESS |
| CONTRACTOR PHONE |
| CONTRACTOR EMAIL |
List all contract(s) currently held with DOC (include contract identification numbers for proper routing):
If contractor enters into any other contract(s) with the DOC prior to the expiration of this statement of compliance, the contractor need not submit an additional compliance form. This completed form shall cover all contract(s) the contractor has with the DOC for a twelve (12) month period, following the date signed by the authorized contractor representative identified above.
During the life of the contract(s), the contractor shall continue to verify compliance on an annual basis, by filing a new completed, signed form with DOC Purchasing Services every twelve (12) months, or within 30 days of each contact year end date or date listed below, whichever is earlier.
| SIGNATURE |
| DATE SIGNED |
Return completed and signed form to:
Or to the DOC Purchasing Helpdesk DOCPurchasingHelpdesk@wisconsin.gov
DISTRIBUTION: Original – Contractor File
File details come from the government source that posted it. Updated .