Fillable_OMESFormCP076.pdf
PDF 224 KB Posted
- Solicitation number
- EV00000672
- Issued by
- Tulsa County, Oklahoma
About this file
This document is an Oklahoma Office of Management & Enterprise Services (OMES) "Responding Bidder Information" form (OMES FORM CP 076), which serves as a mandatory certification document for competitive bid and contract submissions. The two-page form requires bidders to provide comprehensive company information, including contact details, federal identification numbers, and responses to specific state-specific requirements such as registration with the Oklahoma Secretary of State, workers' compensation insurance coverage, and participation in any boycotts.
The form includes critical compliance sections requiring bidders to disclose their status regarding the Disabled Veteran Business Enterprise Act, with options to certify as a service-disabled veteran business if meeting specific ownership and management criteria. Bidders must also declare whether they are currently engaged in a boycott of goods or services from Israel and provide proof of workers' compensation insurance coverage or document an exemption. The form is designed to ensure transparency, verify vendor qualifications, and capture essential information for state procurement processes, with specific references to Oklahoma statutes and regulatory requirements.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Amendment_1.docx | DOCX document | |
| OMESFormCP004.pdf | ||
| Exhibit_4_-ReferenceSheet-post_with_bid_(2).docx | DOCX document | |
| Exhibit_2_-ExecutiveSummaryWorksheet_(2).xlsx | XLSX spreadsheet | |
| Exhibit_3_Pricing_.docx | DOCX document | |
| Attachment_B_-_Updated.docx | DOCX document | |
| Exhibit_7_Risk_Assessment_.docx | DOCX document | |
| Amendment_4.docx | DOCX document | |
| Agency_Bid_Instructions_-_edited.docx | DOCX document | |
| BID_PACKET_ATTACHMENTS_INSTRUCTIONS.pdf | ||
| Exhibit_6_Past_Performance__(002).docx | DOCX document | |
| Amendment3.docx | DOCX document | |
| Amendment_2.docx | DOCX document | |
| Attachment_A_Agency_Purpose_edited_.docx | DOCX document | |
| Exhibit_1_Requirements__.docx | DOCX document | |
| Exhibit_5_-ThirdPartySupplierInfo_.xlsx | XLSX spreadsheet |
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Text version
OMES FORM CP 076 Rev. 11/2020 PAGE 1 OF 2
Responding Bidder Information
“Certification for Competitive Bid and Contract” MUST be submitted along with the response to the Solicitation.
1. RE: Solicitation #: ______________________________________
2. Bidder General Information:
FEI / SSN : Supplier ID:
Company Name:
3. Bidder Contact Information:
Address:
City: State: Zip Code:
Contact Name:
Contact Title:
Phone #: Fax #:
Email: Website:
4. Bidder currently engaged in a boycott of goods or services from Israel.
YES
NO
5. Registration with the Oklahoma Secretary of State: (if over $25,000)
YES - Filing Number:
NO - Prior to the contract award, the successful bidder will be required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (www.sos.ok.gov or 405-521-3911).
6. Workers’ Compensation Insurance Coverage:
Bidder is required to provide with the bid a certificate of insurance showing proof of compliance with the Oklahoma Workers’ Compensation Act.
YES – Include with the bid a certificate of insurance.
NO – Exempt from the Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11) – Attach a written, signed, and dated statement on letterhead stating the reason for the exempt status.1
1 For frequently asked questions concerning workers’ compensation insurance, see https://www.ok.gov/wcc/Insurance/index.html http://www.sos.ok.gov/ https://www.ok.gov/wcc/Insurance/index.html
OMES FORM CP 076 Rev. 11/2020 PAGE 2 OF 2
7. Disabled Veteran Business Enterprise Act
YES – I am a service-disabled veteran business as defined in 74 O.S. §85.44E. Include with the bid response 1) certification of service-disabled veteran status as verified by the appropriate federal agency, and 2) verification of not less than 51% ownership by one or more service-disabled veterans, and 3) verification of the control of the management and daily business operations by one or more service-disabled veterans.
NO – Do not meet the criteria as a service-disabled veteran business.
Authorized Signature Date
Printed Name Title
| Certification for Competitive Bid and Contract MUST be submitted along with the response to the Solicitation: |
| RE Solicitation: |
| FEI SSN: |
| Supplier ID: |
| Company Name: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Contact Name: |
| Contact Title: |
| Phone: |
| Fax: |
| Email: |
| Website: |
| Bidder currently engaged in a boycott of goods or services from Israel: Off |
| Registration with the Oklahoma Secretary of State if over 25000: |
| YES Filing Number: Off |
| NO Prior to the contract award the successful bidder will be required to register with the Secretary of: Off |
| YES Include with the bid a certificate of insurance: Off |
| NO Exempt from the Workers Compensation Act pursuant to 85A OS 218b111 Attach a: Off |
| YES I am a servicedisabled veteran business as defined in 74 OS 8544E Include with the bid: Off |
| NO Do not meet the criteria as a servicedisabled veteran business: Off |
| Date: |
| Printed Name: |
| Title: |
| Signature2_es_:signer:signature: |
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