Exhibit E - Vendor Disclosure Statement.pdf
PDF 41 KB Posted
- Attached to
- CMS #211060 RFQ Pre-Disaster DRR
- Solicitation number
- RFQ NLAA 2027000003 1
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Vendor Disclosure Statement form required by Colorado Revised Statute 24-102-206 for state contracts and solicitations for services executed after August 3, 2007. The form applies to the Colorado CMS #211060 RFQ for Pre-Disaster Disaster Risk Reduction (DRR) services and must be completed by vendors to disclose whether contract performance or subcontract work will occur outside the United States or Colorado. Vendors are required to identify the specific country or state where services will be performed and explain the necessity or business advantage of performing work outside U.S. or Colorado boundaries. The form must be signed by an authorized company representative and returned to the contracting agency prior to contract award.
The disclosure statement exempts certain healthcare-related contracts from the requirement, including those under Medicare, the Colorado Medical Assistance Act, the Children's Basic Health Plan Act, and the Colorado Indigent Care Program. Vendors answering "No" to the question regarding out-of-state or out-of-country performance need only sign and return the form, while those answering "Yes" must provide complete responses to all follow-up questions. This form serves as a transparency and accountability mechanism for state procurement to ensure that public funds support domestic and in-state work unless compelling justification exists otherwise.
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Text version
DPA SB-228 VDS Form Updated 2/14/2008
EXHIBIT E
VENDOR DISCLOSURE STATEMENT
Contract Performance Outside the United States or Colorado
Colorado Revised Statute 24-102-206
Company Name:________________________. Contract or Purchase Order Number:________________ (Contract or PO to be entered after award)
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 “No”, please sign the form.
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.
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
Signature: Printed Name
Title: Date:
RETURN THIS FORM WITH TO THE ADDRESS BELOW
Return to: ______________________________
RETURN THIS FORM WITH TO THE ADDRESS BELOW
File details come from the government source that posted it. Updated .