FORMS___Instructions_to_Attach.pdf

BID PACKET ATTACHMENTS INSTRUCTIONS

To assist in where to attach your response in the supplier portal.

Please see example below:

OMES FORM CP 004 Rev. 08/2023 PAGE 1 OF 1

NOTE: A certification shall be included with any competitive bid and/or contract exceeding $25,000.00 submitted to the State for goods or services.

Agency Name: Agency #:

Supplier or Bidder Legal Name:

Solicitation or Purchase Order #:

SECTION I [74 O.S. § 85.22]:

A. For purposes of competitive bid or contract executed by the state for an acquisition in excess of the fair and reasonable acquisition threshold amount, I certify:,

1. I am the duly authorized agent of the above-named supplier or bidder, for the purpose of certifying the facts pertaining to the existence of collusion among and between bidders and suppliers and state officials or employees, as well as facts pertaining to the giving or offering of things of value to government personnel in return for special consideration in connection with the prospective acquisition.

2. I am fully aware of the facts and circumstances surrounding the acquisition or making of the bid to which this statement relates and have been personally and directly involved in the events leading to the acquisition or submission of such bid;

and

3. Neither the business entity that I represent in this certification nor anyone subject to the business entity’s direction or control has been a party:

a. to any collusion among bidders or suppliers in restraint of freedom of competition by agreement to bid or contract at a fixed price or to refrain from bidding or contracting,

b. to any collusion with any state official or employee as to quantity, quality or price in the prospective contract, or as to any other terms of such prospective contract, nor

c. to any discussions between bidders or suppliers and any state official concerning exchange of money or other thing of value for special consideration in connection with the prospective contract.

B. I certify, if awarded the contract, whether competitively bid or not, neither the business entity I represent nor anyone subject to the business entity’s direction or control has paid, given or donated or agreed to pay, give or donate to any officer or employee of this state any money or other thing of value, either directly or indirectly, in procuring the contract to which this statement relates.

SECTION II [74 O.S. § 85.42]:

For the purpose of a contract for services, the supplier also certifies that no person who has been involved in any manner in the development of this contract while employed by the State of Oklahoma shall be employed by the supplier to fulfill any of the services provided for under said contract.

SECTION III [74 O.S. § 582]:

For the purpose of a contract for goods or services, the supplier also certifies it is not currently engaged in a boycott of goods or services from Israel that constitutes an integral part of business conducted or sought to be conducted with the state.

SECTION IV [74 O.S. § 12005]:

For the purpose of a contract for goods or services, the supplier also certifies it is not currently engaged in a boycott of energy companies and will not boycott energy companies during the term of the contract.

SECTION V DEBARMENT, SUSPENSION OR OTHER RESPONSIBILITY MATTERS:

For the purpose of a contract for goods or services, the supplier certifies any debarment, suspension, indictments, convictions, civil judgments and terminated public contracts have been disclosed to the State Purchasing Director.

The undersigned, duly authorized agent for the above named bidder or supplier, by signing below acknowledges this certification statement is executed for the purposes of:

the competitive bid attached herewith and contract, if awarded to said supplier;

OR

the contract attached herewith, which was not competitively bid and awarded by the agency pursuant to applicable Oklahoma statutes.

Certification for Competitive Bid and/or Contract

Non-Collusion Certification

OMES FORM CP 004 Rev. 08/2023 PAGE 1 OF 1

Printed Name Title

Fax Number

Supplier Authorized Signature Certified This Date

Phone Number Email

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 $250,000)

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